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Andrade AYTD, Canicoba ARB, Oliveira RA, Gnatta JR, de Brito Poveda V. Risk factors for infection associated with the use of external ventricular drainage: a systematic review with meta-analysis. J Hosp Infect 2024:S0195-6701(24)00253-6. [PMID: 39032570 DOI: 10.1016/j.jhin.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/26/2024] [Accepted: 07/08/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Infection associated with the use of the External Ventricular Drainage (EVD) catheter in neurosurgery is linked to high morbidity and mortality, and various mechanisms are related to its occurrence. This systematic review aims to summarise and update the risk factors associated with EVD-related infection. METHOD Systematic review with meta-analysis, utilising grey literature and indexed databases. FINDINGS Thirty studies were included, of which nine contributed to the meta-analysis. The reported frequency of EVD-related infection varied from 1.9% to 36%, and the diagnostic criteria for infection were not standardized, with the presence of a positive culture being the most common. The primary microorganisms identified were Staphylococcus sp. and Pseudomonas sp. Key risk factors included duration of catheterisation, frequency of maintenance care, reinsertion, or number of drains. The results of the meta-analysis showed a significant effect in patients with prolonged use of EVDs, with an increase in risk of 1.47 (OR) [CI 95%, 1.03; 2,10] for each day of use (p=0.03), and showed that the number of cerebrospinal fluid collections was higher in the group with infection (p=0.00), while a greater number of EVDs used was related to a significant effect on infection rates (p=0.00), which were revealed from studies with low heterogeneity (I2: 0%). CONCLUSION The results indicated studies with high heterogeneity and low quality of evidence, with risk factors associated with the maintenance or management of EVD.
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Affiliation(s)
| | | | - Ramon Antônio Oliveira
- Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, São Paulo, Brazil
| | - Juliana Rizzo Gnatta
- Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, São Paulo, Brazil; Core Staff Member of The Brazilian Centre for Evidence-based Healthcare. São Paulo, Brazil
| | - Vanessa de Brito Poveda
- Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, São Paulo, Brazil; Core Staff Member of The Brazilian Centre for Evidence-based Healthcare. São Paulo, Brazil
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Pan X, Haishaer D, Liu M, Zhou S, Na H, Zhao H. Diagnostic, monitoring, and prognostic value of combined detection of cerebrospinal fluid heparin-binding protein, interleukin-6, interleukin-10, and procalcitonin for post-neurosurgical intracranial infection. Cytokine 2024; 179:156593. [PMID: 38581866 DOI: 10.1016/j.cyto.2024.156593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 01/03/2024] [Accepted: 04/01/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE Intracranial infection is a common complication after neurosurgery and can increase the length of hospital stay, affect patient prognosis, and increase mortality. We aimed to investigate the value of the combined detection of cerebrospinal fluid (CSF) heparin-binding protein (HBP), interleukin-6 (IL-6), interleukin-10 (IL-10), and procalcitonin (PCT) for post-neurosurgical intracranial infection. METHODS This study assessed the diagnostic values of CSF HBP, IL-6, IL-10, PCT levels, and combined assays for post-neurosurgical intracranial infection with the area under the receiver operating characteristic (ROC) curve by retrospectively analysing biomarkers of post-neurosurgical patients. RESULTS The CSF HBP, IL-6, IL-10, and PCT levels were significantly higher in the infected group than the uninfected group and the control group (P < 0.001). The indicators in the groups with severe intracranial infections were significantly higher than those in the groups with mild intracranial infections (P < 0.001), and the groups with poor prognoses had significantly higher indexes than the groups with good prognoses. According to the ROC curve display, the AUC values of CSF HBP, IL-6, IL-10, and PCT were 0.977 (95 % CI 0.952-1.000), 0.973 (95 % CI 0.949-0.998), 0.884 (95 % CI 0.823-0.946), and 0.819 (95 % CI 0.733-0.904), respectively. The AUC of the combined test was 0.996 (95 % CI 0.989-1.000), which was higher than those of the four indicators alone. CONCLUSION The combined detection can be an important indicator for the diagnosis and disease monitoring of post-neurosurgical intracranial infection.
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Affiliation(s)
- Xinfang Pan
- Department of Laboratory Medical, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenyang 110016, China; Department of Laboratory Medical, Puwan Campus of the Second Hospital of Dalian Medical University, 378 West of Shiji Road, Dalian 116101, China
| | - Dina Haishaer
- Department of Laboratory Medical, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenyang 110016, China
| | - Mei Liu
- Department of Laboratory Medical, Linfen Central Hospital, 17 Jiefangxi Road, Raodu District, Linfen 041000, China
| | - Shaobo Zhou
- Department of Laboratory Medical, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenyang 110016, China
| | - Heya Na
- Department of Laboratory Medical, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenyang 110016, China.
| | - Hongmei Zhao
- Department of Laboratory Medical, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenyang 110016, China.
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3
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Siddiqui H, Parikh G, Doub JB. Bacterial Aggregation in Cerebral Spinal Fluid: The Extent it Occurs and the Clinical Ramifications. Curr Microbiol 2024; 81:205. [PMID: 38831167 DOI: 10.1007/s00284-024-03727-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/01/2024] [Indexed: 06/05/2024]
Abstract
Bacteria can form aggregates in synovial fluid that are resistant to antibiotics, but the ability to form aggregates in cerebral spinal fluid (CSF) is poorly defined. Consequently, the aims of this study were to assess the propensity of four bacterial species to form aggregates in CSF under various conditions. To achieve these aims, bacteria were added to CSF in microwell plates and small flasks at static and different dynamic conditions with the aid of an incubating shaker. The aggregates that formed were assessed for antibiotic resistance and the ability of tissue plasminogen activator (TPA) to disrupt these aggregates and reduce the number of bacteria present when used with antibiotics. The results of this study show that under dynamic conditions all four bacteria species formed aggregates that were resistant to high concentrations of antibiotics. Yet with static conditions, no bacteria formed aggregates and when the CSF volume was increased, only Staphylococcus aureus formed aggregates. Interestingly, the aggregates that formed were easily dispersed by TPA and significant (p < 0.005) decreases in colony-forming units were seen when a combination of TPA and antibiotics were compared to antibiotics alone. These findings have clinical significance in that they show bacterial aggregation does not habitually occur in central nervous system infections, but rather occurs under specific conditions. Furthermore, the use of TPA combined with antibiotics may be advantageous in recalcitrant central nervous system infections and this provides a pathophysiological explanation for an unusual finding in the CLEAR III clinical trial.
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Affiliation(s)
- Hamda Siddiqui
- The Doub Laboratory of Translational Bacterial Research, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, MD, 21201, USA
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, MD, 21201, USA
| | - Gunjan Parikh
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - James B Doub
- The Doub Laboratory of Translational Bacterial Research, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, MD, 21201, USA.
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, MD, 21201, USA.
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Pietrzko E, Bögli S, Frick K, Ebner-Dietler S, Capone C, Imkamp F, Koliwer-Brandl H, Müller N, Keller E, Brandi G. Broad Range Eubacterial Polymerase Chain Reaction of Cerebrospinal Fluid Reduces the Time to Exclusion of and Costs Associated with Ventriculostomy-Related Infection in Hemorrhagic Stroke. Neurocrit Care 2024; 40:1109-1116. [PMID: 38087175 PMCID: PMC11147905 DOI: 10.1007/s12028-023-01888-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/31/2023] [Indexed: 01/04/2024]
Abstract
BACKGROUND Patients with hemorrhagic stroke and an external ventricular drain in situ are at risk for ventriculostomy-related-infections (VRI). Because of the contamination of the cerebrospinal fluid (CSF) with blood and the high frequency of false negative CSF culture, the diagnosis of VRI remains challenging. This study investigated the introduction of CSF broad range eubacterial polymerase chain reaction (ePCR) and its effect on frequency and duration of antibiotic therapy for VRI, neurocritical care unit (NCCU) length of stay, related costs, and outcome. METHODS Between 2020 and 2022, we prospectively included 193 patients admitted to the NCCU of the University Hospital of Zürich with hemorrhagic stroke and an external ventricular drain for more than 48 h. Patient characteristics, serum inflammatory markers, white blood cell count in CSF, use and duration of antibiotic treatment for VRI, microbiological findings (CSF cultures and ePCR tests), and NCCU length of stay were compared in patients with no infection, noncerebral infection, suspected VRI, and confirmed VRI. Data of patients with suspected VRI of this cohort were compared with a retrospective cohort of patients with suspected VRI treated at our NCCU before the introduction of CSF ePCR testing (2013-2019). RESULTS Out of 193 patients, 12 (6%) were diagnosed with a confirmed VRI, 66 (34%) with suspected VRI, 90 (47%) with a noncerebral infection, and 25 (13%) had no infection at all. Compared with the retrospective cohort of patients, the use of CSF ePCR resulted in a reduction of patients treated for suspected VRI for the whole duration of 14 days (from 51 to 11%). Furthermore, compared with the retrospective group of patients with suspected VRI (n = 67), after the introduction of CSF ePCR, patients with suspected VRI had shorter antibiotic treatment duration of almost 10 days and, hence, lower related costs with comparable outcome at 3 months. CONCLUSIONS The use of CSF ePCR to identify VRI resulted in shorter antibiotic treatment duration without changing the outcome, as compared with a retrospective cohort of patients with suspected VRI.
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Affiliation(s)
- Elisabeth Pietrzko
- Neurocritical Care Unit, Institute of Intensive Care, University Hospital of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland.
| | - Stefan Bögli
- Neurocritical Care Unit, Institute of Intensive Care, University Hospital of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
- Department of Neurology, Clinical Neuroscience Center Zürich, University Hospital Zürich, Frauenklinikstrasse 26, 8091, Zürich, Switzerland
| | - Katja Frick
- Neurocritical Care Unit, Institute of Intensive Care, University Hospital of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Sabeth Ebner-Dietler
- Neurocritical Care Unit, Institute of Intensive Care, University Hospital of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Crescenzo Capone
- Neurocritical Care Unit, Institute of Intensive Care, University Hospital of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Frank Imkamp
- Institute of Medical Microbiology, University of Zürich, Gloriastrasse 28/30, 8006, Zürich, Switzerland
| | - Hendrik Koliwer-Brandl
- Institute of Medical Microbiology, University of Zürich, Gloriastrasse 28/30, 8006, Zürich, Switzerland
| | - Nicolas Müller
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Emanuela Keller
- Neurocritical Care Unit, Institute of Intensive Care, University Hospital of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
- Department of Neurosurgery, University Hospital Zürich, Frauenklinikstrasse 10, 8091, Zürich, Switzerland
| | - Giovanna Brandi
- Neurocritical Care Unit, Institute of Intensive Care, University Hospital of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
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Volpicelli L, Cairoli S, Al Ismail D, Baisi F, Sacco F, Goffredo BM, Venditti M, Oliva A. Simultaneous post-neurosurgical ventriculitis and bacteraemia by two different strains of KPC-producing K. pneumoniae successfully treated with meropenem/vaborbactam and high dose of fosfomycin. J Glob Antimicrob Resist 2024; 37:86-90. [PMID: 38519025 DOI: 10.1016/j.jgar.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/10/2024] [Accepted: 03/09/2024] [Indexed: 03/24/2024] Open
Abstract
OBJECTIVE A case of post-neurosurgical ventriculitis caused by a KPC-producing Klebsiella pneumoniae (KPC-Kp) with a ceftazidime/avibactam-resistant, meropenem-susceptible phenotype is reported. METHODS AND RESULTS The patient had a concomitant bloodstream infection with a wild-type KPC-Kp with a ceftazidime/avibactam-susceptible, meropenem-resistant phenotype. Prolonged treatment with intravenous fosfomycin and meropenem/vaborbactam achieved clinical success. Therapeutic drug monitoring performed during the first days of treatment showed for the first time that vaborbactam efficiently penetrates cerebrospinal fluid. In contrast, meropenem was undetectable in cerebrospinal fluid at each sampling, suggesting that additional doses of meropenem may be required to appropriately prescribe meropenem/vaborbactam for central nervous system infections. Plasma and cerebrospinal fluid levels of fosfomycin were adequate, confirming the potential of this agent possibly even in the fight against multidrug-resistant organisms. CONCLUSIONS This case highlights the need for therapeutic drug monitoring as a crucial tool for optimizing treatment in complicated cases where the pharmacokinetic behaviour of antibiotics is difficult to predict.
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Affiliation(s)
- Lorenzo Volpicelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Sara Cairoli
- Division of Metabolic Diseases and Drug Biology, Department of Pediatric Specialties and Liver-Kidney Transplantation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Dania Al Ismail
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Floriana Baisi
- Department of General and Specialistic Surgery, Sapienza University of Rome, Rome, Italy
| | - Federica Sacco
- Microbiology and Virology Laboratory, Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Bianca Maria Goffredo
- Division of Metabolic Diseases and Drug Biology, Department of Pediatric Specialties and Liver-Kidney Transplantation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
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Rubino R, Trizzino M, Pipitò L, Sucato G, Santoro M, Maugeri R, Iacopino DG, Giammanco GM, Siragusa S, Cascio A. A Difficult Case of Ventriculitis in a 40-Year-Old Woman with Acute Myeloid Leukemia. Antibiotics (Basel) 2024; 13:432. [PMID: 38786160 PMCID: PMC11117259 DOI: 10.3390/antibiotics13050432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 04/30/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
Ventriculitis and nosocomial meningitis caused by carbapenem-resistant Gram-negative and vancomycin-resistant Gram-positive bacteria represent a growing treatment challenge. A case of ventriculitis and bacteremia caused by carbapenem-resistant, KPC-producing Klebsiella pneumoniae and vancomycin-resistant Enterococcus faecium in a young woman with acute leukemia who was successfully treated with meropenem/vaborbactam (MVB), rifampicin, and linezolid is described in this paper. This case report emphasizes the importance of a multidisciplinary strategy, including infectious focus control, for the treatment of device-associated central nervous system (CNS) infections from multidrug-resistant bacteria. Considering the novel resistance patterns, more research on drug penetration into the central nervous system, as well as on the necessity of association therapies, is needed.
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Affiliation(s)
- Raffaella Rubino
- Infectious and Tropical Diseases Unit, Sicilian Regional Reference Center for the Fight against AIDS, AOU Policlinico “P. Giaccone”, 90127 Palermo, Italy; (M.T.); (A.C.)
- Antimicrobial Stewardship Team, AOU Policlinico “P. Giaccone”, 90127 Palermo, Italy
| | - Marcello Trizzino
- Infectious and Tropical Diseases Unit, Sicilian Regional Reference Center for the Fight against AIDS, AOU Policlinico “P. Giaccone”, 90127 Palermo, Italy; (M.T.); (A.C.)
| | - Luca Pipitò
- Infectious and Tropical Diseases Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy;
| | - Giuseppe Sucato
- Hematology Unit, University Hospital Paolo Giaccone, 90127 Palermo, Italy; (G.S.); (M.S.); (S.S.)
| | - Marco Santoro
- Hematology Unit, University Hospital Paolo Giaccone, 90127 Palermo, Italy; (G.S.); (M.S.); (S.S.)
| | - Rosario Maugeri
- Neurosurgical Clinic, AOU Policlinico “P. Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (R.M.); (D.G.I.)
| | - Domenico Gerardo Iacopino
- Neurosurgical Clinic, AOU Policlinico “P. Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (R.M.); (D.G.I.)
| | - Giovanni Maurizio Giammanco
- UOC of Microbiology, Virology and Parasitology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy;
| | - Sergio Siragusa
- Hematology Unit, University Hospital Paolo Giaccone, 90127 Palermo, Italy; (G.S.); (M.S.); (S.S.)
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy
| | - Antonio Cascio
- Infectious and Tropical Diseases Unit, Sicilian Regional Reference Center for the Fight against AIDS, AOU Policlinico “P. Giaccone”, 90127 Palermo, Italy; (M.T.); (A.C.)
- Antimicrobial Stewardship Team, AOU Policlinico “P. Giaccone”, 90127 Palermo, Italy
- Infectious and Tropical Diseases Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy;
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7
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Hu Y, Li D, Zhang G, Dai Y, Chen M, Jiang H, Cui W. Intraventricular or intrathecal polymyxin B for treatment of post-neurosurgical intracranial infection caused by carbapenem-resistant gram-negative bacteria: a 8-year retrospective study. Eur J Clin Microbiol Infect Dis 2024; 43:875-884. [PMID: 38443737 PMCID: PMC11108910 DOI: 10.1007/s10096-024-04794-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/26/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE Post-neurosurgical intracranial infection caused by carbapenem-resistant gram-negative bacteria (CRGNB) is a life-threatening complication. This study aimed to assess the current practices and clinical outcomes of intravenous (IV) combined with intraventricular (IVT)/intrathecal (ITH) polymyxin B in treating CRGNB intracranial infection. METHODS A retrospective study was conducted on patients with post-neurosurgical intracranial infection due to CRGNB from January 2013 to December 2020. Clinical characteristics and treatment outcomes were collected and described. Kaplan-Meier survival and multivariate logistic regression analyses were performed. RESULTS The study included 114 patients, of which 72 received systemic antimicrobial therapy combined with IVT/ITH polymyxin B, and 42 received IV administration alone. Most infections were caused by carbapenem-resistant Acinetobacter baumannii (CRAB, 63.2%), followed by carbapenem-resistant Klebsiella pneumoniae (CRKP, 31.6%). Compared with the IV group, the IVT/ITH group had a higher cerebrospinal fluid (CSF) sterilization rate in 7 days (p < 0.001) and lower 30-day mortality (p = 0.032). In the IVT/ITH group, patients with CRKP infection had a higher initial fever (p = 0.014), higher incidence of bloodstream infection (p = 0.040), lower CSF sterilization in 7 days (p < 0.001), and higher 30-day mortality (p = 0.005) than those with CRAB infection. Multivariate logistic regression analysis revealed that the duration of IVT/ITH polymyxin B (p = 0.021) was independently associated with 30-day mortality. CONCLUSIONS Intravenous combined with IVT/ITH polymyxin B increased CSF microbiological eradication and improved clinical outcomes. CRKP intracranial infections may lead to more difficult treatment and thus warrant attention and further optimized treatment.
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Affiliation(s)
- Yangmin Hu
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
| | - Danyang Li
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Gensheng Zhang
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Yunjian Dai
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Meng Chen
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Huifang Jiang
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Wei Cui
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
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Condos AM, Wangaryattawanich P, Rath TJ. Bacterial, Viral, and Prion Infectious Diseases of the Brain. Magn Reson Imaging Clin N Am 2024; 32:289-311. [PMID: 38555142 DOI: 10.1016/j.mric.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Diagnosis of brain infections is based on a combination of clinical features, laboratory markers, and imaging findings. Imaging characterizes the extent and severity of the disease, aids in guiding diagnostic and therapeutic procedures, monitors response to treatment, and demonstrates complications. This review highlights the characteristic imaging manifestations of bacterial and viral infections in the brain.
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Affiliation(s)
- Amy M Condos
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA.
| | - Pattana Wangaryattawanich
- Department of Radiology, University of Washington School of Medicine, 1959 Northeast Pacific Street, Seattle, WA 98195-7115, USA
| | - Tanya J Rath
- Neuroradiology Section, Department of Radiology, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
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9
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Corona-Nakamura AL, Arias-Merino MJ, Ávila-Esparza EI, Tolentino-Corona MDL, Cañedo-Castañeda CC, Flores-Salinas HE, Corona-Macías JF, Vázquez-Arias ME. Ventriculitis due to multidrug-resistant gram-negative bacilli associated with external ventricular drain: evolution, treatment, and outcomes. Front Neurol 2024; 15:1384206. [PMID: 38737346 PMCID: PMC11082300 DOI: 10.3389/fneur.2024.1384206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/04/2024] [Indexed: 05/14/2024] Open
Abstract
Introduction Nosocomial infectious ventriculitis caused by multidrug-resistant (MDR) Gram-negative bacilli associated with external ventricular drainage (EVD) placement poses a significant mortality burden and hospital costs. Objectives This study aims to analyze the characteristics, ventriculitis evolution, treatment, and outcomes of patients with ventriculitis due to MDR Gram-negative bacilli associated with EVD placement. Methods A retrospective cohort study focusing on patients with nosocomial infection caused by MDR Gram-negative bacilli while on EVD was conducted from 2019 to 2022. Medical, laboratory, and microbiological records were collected. The antibiotic resistance of the Gram-negative bacilli isolated in the cerebrospinal fluid (CSF) of patients was analyzed. The risk factors were identified using univariate risk models and were analyzed using survival curves (Cox regression). An adjusted Cox proportional hazards model was also constructed. Results Among 530 patients with suspected EVD-associated ventriculitis, 64 patients with isolation of Gram-negative bacilli in CSF were included. The estimated mortality was 78.12%. Hemorrhages (intracranial, subarachnoid, and intraventricular) were observed in 69.8% of patients. Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa were the most frequently isolated bacilli. In the univariate analysis, significant risk factors for mortality included arterial hypertension, a Glasgow Coma Scale (GCS) score of ≤ 8, invasive mechanical ventilation (IMV) upon hospital admission and during hospitalization, septic shock, and ineffective treatment. The adjusted Cox proportional hazards model revealed that septic shock (HR = 3.3, 95% CI = 1.5-7.2; p = 0.003) and ineffective treatment (HR = 3.2, 1.6-6.5, 0.001) were significant predictors. A high resistance to carbapenems was found for A. baumannii (91.3%) and P. aeruginosa (80.0%). Low resistance to colistin was found for A. baumannii (4.8%) and P. aeruginosa (12.5%). Conclusion Ineffective treatment was an independent hazard factor for death in patients with ventriculitis caused by MDR Gram-negative bacilli associated with EVD.
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Affiliation(s)
- Ana Luisa Corona-Nakamura
- Department of Internal Medicine, Mexican Institute of Social Security, Western National Medical Center, High Specialty Medical Unit, Guadalajara, Mexico
| | | | - Eleazar Iván Ávila-Esparza
- Department of Internal Medicine, Mexican Institute of Social Security, Western National Medical Center, High Specialty Medical Unit, Guadalajara, Mexico
| | - María de Lourdes Tolentino-Corona
- Department of Internal Medicine, Mexican Institute of Social Security, Western National Medical Center, High Specialty Medical Unit, Guadalajara, Mexico
| | - César Cuauhtémoc Cañedo-Castañeda
- Department of Neurosurgery, Mexican Institute of Social Security, Western National Medical Center, High Specialty Medical Unit, Guadalajara, Mexico
| | - Héctor Enrique Flores-Salinas
- Department of Internal Medicine, Mexican Institute of Social Security, Western National Medical Center, High Specialty Medical Unit, Guadalajara, Mexico
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Xu J, Du X, Li D, Li P, Guo Q, Xu X, Hu F, Wang M. Clinical characteristics and antimicrobial therapy of healthcare-associated carbapenem-non-susceptible gram-negative bacterial meningitis: a 16-year retrospective cohort study. BMC Infect Dis 2024; 24:368. [PMID: 38566040 PMCID: PMC10985894 DOI: 10.1186/s12879-024-09237-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 03/19/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE Healthcare-associated Gram-negative bacterial meningitis is a substantial clinical issue with poor outcomes, especially for neurosurgical patients. Here, we aimed to study the characteristics and treatment options of patients with healthcare-associated carbapenem-non-susceptible (Carba-NS) Gram-negative bacterial meningitis. METHODS This observational cohort study was conducted at a teaching hospital from 2004 to 2019. The clinical characteristics of patients with meningitis with Carba-NS and carbapenem-susceptible (Carba-S) bacilli were compared, and the antimicrobial chemotherapy regimens and outcomes for Carba-NS Gram-negative bacterial meningitis were analyzed. RESULTS A total of 505 patients were included, of whom 83.8% were post-neurosurgical patients. The most common isolates were Acinetobacter spp. and Klebsiella spp., which had meropenem-resistance rates of 50.6% and 42.5%, respectively, and showed a markedly growing carbapenem-resistance trend. Kaplan-Meier curve analysis revealed that Carba-NS Gram-negative bacilli were associated with a significantly higher in-hospital mortality rate (18.8%, 35/186) compared to the Carba-S group (7.4%, 9/122; P = 0.001). For Carba-NS Enterobacterales meningitis, aminoglycoside-based and trimethoprim-sulfamethoxazole-based regimens yielded significantly higher clinical efficacy rates than non-aminoglycoside-based and non-trimethoprim-sulfamethoxazole-based regimens (69.0% vs. 38.7%, P = 0.019 and 81.8% vs. 46.9%, P = 0.036, respectively). For Carba-NS A. baumannii complex meningitis, tetracycline-based (including doxycycline, minocycline, or tigecycline) therapy achieved a significantly higher clinical efficacy rate (62.9%, 22/35) than the non-tetracycline-based therapy group (40.4%, 19/47; P = 0.044). CONCLUSIONS Our findings revealed that Carba-NS Gram-negative bacilli are associated with higher in-hospital mortality in patients with healthcare-associated meningitis. The combination therapies involving particular old antibiotics may improve patients' outcome. TRIAL REGISTRATION This study was registered on the Chinese Clinical Trial Register under ChiCTR2000036572 (08/2020).
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Affiliation(s)
- Jiyan Xu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, 200040, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Heath Commission of People's Republic of China, Shanghai, China
| | - Xiaoling Du
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, 200040, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Heath Commission of People's Republic of China, Shanghai, China
| | - Dan Li
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, 200040, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Heath Commission of People's Republic of China, Shanghai, China
| | - Pei Li
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, 200040, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Heath Commission of People's Republic of China, Shanghai, China
| | - Qinglan Guo
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, 200040, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Heath Commission of People's Republic of China, Shanghai, China
| | - Xiaogang Xu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, 200040, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Heath Commission of People's Republic of China, Shanghai, China
| | - Fupin Hu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, 200040, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Heath Commission of People's Republic of China, Shanghai, China
| | - Minggui Wang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, 200040, China.
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Heath Commission of People's Republic of China, Shanghai, China.
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11
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Ngougni Pokem P, Liu X, Parker SL, Verroken A, Collienne C, Finet P, Wijnant GJ, Laterre PF, Roberts JA, Van Bambeke F, Wittebole X. Population pharmacokinetics and dosing simulations of total and unbound temocillin in the plasma and CSF of neurocritically ill patients with external ventricular drain-related cerebral ventriculitis. J Antimicrob Chemother 2024; 79:429-442. [PMID: 38153240 DOI: 10.1093/jac/dkad398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 12/12/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND Cerebral ventriculitis might be caused by Gram-negative bacteria, including ESBL producers. Temocillin may be a useful treatment option in this scenario; however, no consistent data are available regarding its penetration into the CSF. OBJECTIVES To describe the population pharmacokinetics of temocillin in plasma and CSF and to determine the probability for different simulated dosing regimens to achieve pharmacokinetic/pharmacodynamic (PK/PD) targets in the CSF. METHODS Ten post-neurosurgical critically ill adult patients requiring continuous drainage of CSF were included in this monocentric, prospective, open-label, non-randomized study. They received 2 g loading dose temocillin over 30 min IV infusion, followed by a 6 g continuous infusion over 24 h. Total and unbound concentrations were measured in plasma (n = 88 and 86) and CSF (n = 88 and 88) samples and used to build a population PK model. Monte Carlo simulations were performed to estimate the PTA at 100% Css>MIC (steady state concentration above the MIC) in CSF. RESULTS All patients were infected with Enterobacterales with temocillin MICs ≤8 mg/L. The median (min-max) temocillin penetration in CSF was 12.1% (4.3-25.5) at steady state. Temocillin unbound plasma pharmacokinetics were best described by a one-compartment model. PTA for the applied dosing regimen was >90% for bacteria with MIC ≤ 4 mg/L. CONCLUSIONS The currently approved dose of 6 g by continuous infusion may be adequate for the treatment of ventriculitis by Enterobacterales with MIC ≤ 4 mg/L if considering 100% Css>MIC as the PK/PD target to reach. Higher maintenance doses could help covering higher MICs, but their safety would need to be assessed.
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Affiliation(s)
- Perrin Ngougni Pokem
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Avenue E. Mounier 73/B1.73.05, B-1200, Brussels, Belgium
| | - Xin Liu
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Suzanne L Parker
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Alexia Verroken
- Clinical Microbiology Department, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Christine Collienne
- Department of Critical Care Medicine, Cliniques universitaires St Luc, Université catholique de Louvain, Brussels, Belgium
| | - Patrice Finet
- Department of Neurosurgery, Cliniques universitaires St Luc, Université catholique de Louvain, Brussels, Belgium
| | - Gert-Jan Wijnant
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Avenue E. Mounier 73/B1.73.05, B-1200, Brussels, Belgium
| | - Pierre-François Laterre
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Jason A Roberts
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, Australia
- Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Françoise Van Bambeke
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Avenue E. Mounier 73/B1.73.05, B-1200, Brussels, Belgium
| | - Xavier Wittebole
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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12
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Nau R, Seele J, Eiffert H. New Antibiotics for the Treatment of Nosocomial Central Nervous System Infections. Antibiotics (Basel) 2024; 13:58. [PMID: 38247617 PMCID: PMC10812395 DOI: 10.3390/antibiotics13010058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 12/28/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
Nosocomial central nervous system (CNS) infections with carbapenem- and colistin-resistant Gram-negative and vancomycin-resistant Gram-positive bacteria are an increasing therapeutic challenge. Here, we review pharmacokinetic and pharmacodynamic data and clinical experiences with new antibiotics administered intravenously for the treatment of CNS infections by multi-resistant bacteria. Cefiderocol, a new siderophore extended-spectrum cephalosporin, pharmacokinetically behaves similar to established cephalosporins and at high doses will probably be a valuable addition in our therapeutic armamentarium for CNS infections. The new glycopeptides dalbavancin, telavancin, and oritavancin are highly bound to plasma proteins. Although effective in animal models of meningitis, it is unlikely that they reach effective cerebrospinal fluid (CSF) concentrations after intravenous administration alone. The β-lactam/β-lactamase inhibitor combinations have the principal problem that both compounds must achieve adequate CSF concentrations. In the commercially available combinations, the dose of the β-lactamase inhibitor tends to be too low to achieve adequate CSF concentrations. The oxazolidinone tedizolid has a broader spectrum but a less suitable pharmacokinetic profile than linezolid. The halogenated tetracycline eravacycline does not reach CSF concentrations sufficient to treat colistin-resistant Gram-negative bacteria with usual intravenous dosing. Generally, treatment of CNS infections should be intravenous, whenever possible, to avoid adverse effects of intraventricular therapy (IVT). An additional IVT can overcome the limited penetration of many new antibiotics into CSF. It should be considered for patients in which the CNS infection responds poorly to systemic antimicrobial therapy alone.
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Affiliation(s)
- Roland Nau
- Department of Neuropathology, University Medicine Göttingen, Georg-August-University Göttingen, 37075 Göttingen, Germany
- Department of Geriatrics, Protestant Hospital Göttingen-Weende, 37075 Göttingen, Germany
| | - Jana Seele
- Department of Neuropathology, University Medicine Göttingen, Georg-August-University Göttingen, 37075 Göttingen, Germany
- Department of Geriatrics, Protestant Hospital Göttingen-Weende, 37075 Göttingen, Germany
| | - Helmut Eiffert
- Department of Neuropathology, University Medicine Göttingen, Georg-August-University Göttingen, 37075 Göttingen, Germany
- Amedes MVZ for Laboratory Medicine, Medical Microbiology and Infectiology, 37077 Göttingen, Germany
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13
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Koulenti D, Vandana KE, Rello J. Current viewpoint on the epidemiology of nonfermenting Gram-negative bacterial strains. Curr Opin Infect Dis 2023; 36:545-554. [PMID: 37930069 DOI: 10.1097/qco.0000000000000977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
PURPOSE OF REVIEW This article aims to review the epidemiology of nonfermenting Gram-negative bacilli (NFGNB) based on recent literature reports, particularly, of the less common, but with emerging clinical significance species. RECENT FINDINGS The reported frequency of multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa is increasing, with very significant variability, however, between different countries. Apart from the major NFGNB, that is, A. baumannii and P. aeruginosa, already recognized as of critical importance healthcare risks, several other NFGNB genera have been increasingly associated with diverse severe infections, such as Stenotrophomonas maltophilia, Burkholderia spp., Elizabethkingia spp., Chryseobacterium spp., Achromobacter spp., Alcaligenes spp., Sphingomonas spp., Shewanella spp. and Ralstonia spp., among others. SUMMARY The exploration of the epidemiology, as well as the pathogenic potential of the of the less frequent, but emerging and increasingly reported NFGNB, is crucial, not only for immunocompromised patients, but also for critically ill patients without overt immunosuppression. As we are heading fast towards a postantibiotic era, such information would contribute to the optimal antimicrobial management, that is, providing prompt, appropriate antimicrobial coverage when needed and, at the same time, avoiding overuse and/or inappropriate use of antimicrobial therapy. Also, it would help to better understand their transmission dynamics and to develop effective prevention strategies.
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Affiliation(s)
- Despoina Koulenti
- Second Critical Care Department, Attikon University Hospital, Athens, Greece
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Kalwaje Eswhara Vandana
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Jordi Rello
- Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
- FOREVA Research Unit, CHU Nîmes, Nîmes, France
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14
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Mizuno S, Koyama J, Kurosawa H, Kasai M. Treatment optimization by monitoring vancomycin concentration in the serum and cerebrospinal fluid in a child with cystoperitoneal shunt-related infection caused by methicillin-resistant Staphylococcus aureus: a case report and literature review. Childs Nerv Syst 2023; 39:3307-3310. [PMID: 37271777 PMCID: PMC10643370 DOI: 10.1007/s00381-023-06004-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 05/22/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Cerebral ventricular shunt infections caused by methicillin-resistant Staphylococcus aureus (MRSA), especially strains with elevated minimum inhibitory concentration (MIC) values, have a poor prognosis. Monitoring serum vancomycin (VCM) levels with therapeutic drug monitoring and maintaining high VCM concentrations in the cerebrospinal fluid (CSF) are critical to treatment success. However, there have been a few reports about the CSF penetration and the pharmacokinetics of VCM in children. CASE PRESENTATION Here, we report the case of a pediatric patient with cysto-peritoneal shunt-related meningitis caused by MRSA with an MIC of 2 μg/mL. The adequate VCM concentration was maintained by monitoring the VCM concentration in the CSF via the external ventricular drain, and frequent blood taking was avoided. VCM showed a good CSF penetration in our patient, and she was discharged without complications. DISCUSSION Therapeutic drug monitoring of VCM concentration in the CSF may result in successful treatment even if MRSA shows a higher MIC. Therapeutic drug monitoring of VCM concentration in the CSF may also reduce the side effects.
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Affiliation(s)
- Shinsuke Mizuno
- Department of Pediatrics Infectious Disease, Hyogo Prefectural Kobe Children's Hospital, 6500047, Kobe City, Hyogo, Japan.
| | - Junji Koyama
- Department of Neurosurgery, Hyogo Prefectural Kobe Children's Hospital, Kobe City, Hyogo, Japan
| | - Hiroshi Kurosawa
- Department of Pediatric Critical Care Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe City, Hyogo, Japan
| | - Masashi Kasai
- Department of Pediatrics Infectious Disease, Hyogo Prefectural Kobe Children's Hospital, 6500047, Kobe City, Hyogo, Japan
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15
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Wang P, Luo S, Cheng S, Gong M, Zhang J, Liang R, Ma W, Li Y, Liu Y. Construction and validation of infection risk model for patients with external ventricular drainage: a multicenter retrospective study. Acta Neurochir (Wien) 2023; 165:3255-3266. [PMID: 37697007 DOI: 10.1007/s00701-023-05771-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 08/13/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE External ventricular drainage (EVD) is a life-saving neurosurgical procedure, of which the most concerning complication is EVD-related infection (ERI). We aimed to construct and validate an ERI risk model and establish a monographic chart. METHODS We retrospectively analyzed the adult EVD patients in four medical centers and split the data into a training and a validation set. We selected features via single-factor logistic regression and trained the ERI risk model using multi-factor logistic regression. We further evaluated the model discrimination, calibration, and clinical usefulness, with internal and external validation to assess the reproducibility and generalizability. We finally visualized the model as a nomogram and created an online calculator (dynamic nomogram). RESULTS Our research enrolled 439 EVD patients and found 75 cases (17.1%) had ERI. Diabetes, drainage duration, site leakage, and other infections were independent risk factors that we used to fit the ERI risk model. The area under the receiver operating characteristic curve (AUC) and the Brier score of the model were 0.758 and 0.118, and these indicators' values were similar when internally validated. In external validation, the model discrimination had a moderate decline, of which the AUC was 0.720. However, the Brier score was 0.114, suggesting no degradation in overall performance. Spiegelhalter's Z-test indicated that the model had adequate calibration when validated internally or externally (P = 0.464 vs. P = 0.612). The model was transformed into a nomogram with an online calculator built, which is available through the website: https://wang-cdutcm.shinyapps.io/DynNomapp/ . CONCLUSIONS The present study developed an infection risk model for EVD patients, which is freely accessible and may serve as a simple decision tool in the clinic.
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Affiliation(s)
- Peng Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Neurosurgery, Chengdu Fifth People's Hospital/Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Shuang Luo
- Department of Neurosurgery, Chengdu Fifth People's Hospital/Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Shuwen Cheng
- Department of Neurosurgery, Chengdu Fifth People's Hospital/Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Min Gong
- Department of Neurosurgery, Chengdu Fifth People's Hospital/Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jie Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Ruofei Liang
- Department of Neurosurgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Weichao Ma
- Department of Neurosurgery, Sichuan Cancer Hospital, Chengdu, Sichuan, China
| | - Yaxin Li
- West China Fourth Hospital/West China School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - Yanhui Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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16
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Zheng G, Shi Y, Sun J, Wang S, Li X, Lv H, Zhang G. Effect of antibiotic prophylaxis in the prognosis of Post-neurosurgical meningitis patients. Eur J Med Res 2023; 28:396. [PMID: 37794524 PMCID: PMC10548647 DOI: 10.1186/s40001-023-01399-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/27/2023] [Indexed: 10/06/2023] Open
Abstract
AIMS To evaluate the effect of antibiotic prophylaxis(AP) in the prognosis of Post-neurosurgical meningitis(PNM) patients. METHODS A cohort analysis was performed using the clinical database in Beijing Tiantan Hospital and Capital Medical University. Data were collected on patients with the diagnosis of PNM (n = 3931) during 2012.01 to 2022.04. The microbial distribution, types of AP, and 42 and 90 days survival analysis of AP patients were evaluated using probable statistical methods. Independent risk factors for mortality were established by constructing a logistic regression analysis. RESULT A total of 1,190 patients were included in this study, Klebsiella pneumoniae, Acinetobacter baumannii, and Staphylococcus aureus occupied the highest proportion. Of them, 929 cases received AP, cefuroxime and ceftriaxone are the most frequent used antibiotics. In addition, We found that PNM patients without AP significantly increased the 42 days and 90 days all-cause mortality rates. The use of different levels of AP did not improve patient outcomes, and ICU admission and assisted mechanical ventilation (AMV) were identified as independent mortality risk factors for PNM patient received AP. CONCLUSIONS AP plays an important role in the prognosis of PNM patients and has a significant function in improving prognosis. The prevention of PNM with antibiotics prior to neurosurgery should be emphasized in clinical practice, and appropriate selection of antibiotics is necessary to prevent the occurrence of infection and inhibit the emergence of antibiotic-resistant bacteria.
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Affiliation(s)
- Guanghui Zheng
- Clinical Diagnosis Laboratory of Beijing Tiantan Hospital, Capital Medical University, NO. 119 Nansihuan West Road, Fengtai District, Beijing, 100076, China
- NMPA Key Laboratory for Quality Control of In Vitro Diagnostics, Beijing, 100076, China
- Beijing Engineering Research Center of Immunological Reagents Clinical Research, Beijing, 100076, China
| | - Yijun Shi
- Clinical Diagnosis Laboratory of Beijing Tiantan Hospital, Capital Medical University, NO. 119 Nansihuan West Road, Fengtai District, Beijing, 100076, China
- NMPA Key Laboratory for Quality Control of In Vitro Diagnostics, Beijing, 100076, China
- Beijing Engineering Research Center of Immunological Reagents Clinical Research, Beijing, 100076, China
| | - Jialu Sun
- Clinical Diagnosis Laboratory of Beijing Tiantan Hospital, Capital Medical University, NO. 119 Nansihuan West Road, Fengtai District, Beijing, 100076, China
| | - Siqi Wang
- Clinical Diagnosis Laboratory of Beijing Tiantan Hospital, Capital Medical University, NO. 119 Nansihuan West Road, Fengtai District, Beijing, 100076, China
| | - Xiang Li
- Clinical Diagnosis College of Capital Medical University, Beijing, 100076, China
| | - Hong Lv
- Clinical Diagnosis Laboratory of Beijing Tiantan Hospital, Capital Medical University, NO. 119 Nansihuan West Road, Fengtai District, Beijing, 100076, China
- NMPA Key Laboratory for Quality Control of In Vitro Diagnostics, Beijing, 100076, China
- Beijing Engineering Research Center of Immunological Reagents Clinical Research, Beijing, 100076, China
| | - Guojun Zhang
- Clinical Diagnosis Laboratory of Beijing Tiantan Hospital, Capital Medical University, NO. 119 Nansihuan West Road, Fengtai District, Beijing, 100076, China.
- NMPA Key Laboratory for Quality Control of In Vitro Diagnostics, Beijing, 100076, China.
- Beijing Engineering Research Center of Immunological Reagents Clinical Research, Beijing, 100076, China.
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17
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Peláez Bejarano A, García de Lomas JM, Franco-Huertas M, Martínez-Marcos FJ, Jiménez-Hidalgo A. Successful treatment of postsurgical meningitis caused by Bacillus cereus: a case report and literature review. J Chemother 2023; 35:570-575. [PMID: 36484492 DOI: 10.1080/1120009x.2022.2153317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/06/2022] [Accepted: 11/24/2022] [Indexed: 12/13/2022]
Abstract
Bacillus cereus is a spore-forming, gram-positive bacterium that is ubiquitous in the environment. Central nervous system involvement with B. cereus is rare. Despite aggressive treatment with broad-spectrum antibiotics and using them appropriately, the mortality is high. A 72-year-old patient suffered a central nervous system infection associated with postsurgical meningitis and was successfully treated with a novel antibiotic therapy. This study includes the first case report of postsurgical B. cereus meningitis in the last ten years. It provides a different line of treatment to the previous ones.
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Affiliation(s)
- A Peláez Bejarano
- Unidad de Gestión Clínica Farmacia, Área de Gestión Sanitaria Norte de Huelva, Huelva, Spain
| | - J M García de Lomas
- Unidad de Gestión Clínica Enfermedades Infecciosas, Hospital Juan Ramón Jiménez, Huelva, Spain
| | - M Franco-Huertas
- Unidad de Gestión Clínica Enfermedades Infecciosas, Hospital Juan Ramón Jiménez, Huelva, Spain
| | - F J Martínez-Marcos
- Unidad de Gestión Clínica Enfermedades Infecciosas, Hospital Juan Ramón Jiménez, Huelva, Spain
| | - A Jiménez-Hidalgo
- Unidad de Gestión Clínica Enfermedades Infecciosas, Hospital Juan Ramón Jiménez, Huelva, Spain
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18
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Licona-Enríquez JD, Labra-Zamora MG, Ramírez-Reyes AG, Miranda-Novales MG. Healthcare-Associated Ventriculitis in Children during COVID-19 Pandemic: Clinical Characteristics and Outcome of a First Infection. Antibiotics (Basel) 2023; 12:1501. [PMID: 37887202 PMCID: PMC10604527 DOI: 10.3390/antibiotics12101501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/28/2023] Open
Abstract
During the COVID-19 pandemic, patients in need of neurosurgical care suffered. Elective procedures were postponed, and emergency care visits decreased. Healthcare-associated ventriculitis (HAV) is a serious problem in children, with poor outcomes and frequent relapses. Our objective was to describe the clinical characteristics and the factors associated with a first HAV in children during two years of the pandemic. A retrospective cross-sectional study was performed from January 2021 to December 2022. The inclusion criteria were patients who developed a first HAV after a primary cerebrospinal fluid diversion procedure. The controls included patients without a first infection. Intraoperative and clinical data were extracted from medical records. A total of 199 CSF diversion surgeries were registered. A first infection occurred in 17 patients (8.5%), including 10 with external ventricular drain (EVD) and 6 with ventricular shunts. Gram-positive cocci were identified in 70.6%. Six patients recovered uneventfully, eight had relapse or superinfections, and three eventually died. Twenty patients were included as controls. Factors associated with a first infection were a younger age (median 9 vs. 102 months, p < 0.01), malnutrition (23.5% vs. 0%, p = 0.03), and an EVD placement (58.8% vs. 10%, p = 0.03). None of the intraoperative factors showed statistically significant differences. The rate of HAV was high. Most cases presented in children <1 year and with an EVD.
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Affiliation(s)
- Jesús David Licona-Enríquez
- Infectious Diseases Department, Pediatric Hospital, National Medical Center, XXI Century, Mexican Institute of Social Security, Mexico City 06720, Mexico; (J.D.L.-E.); (M.G.L.-Z.)
| | - María Guadalupe Labra-Zamora
- Infectious Diseases Department, Pediatric Hospital, National Medical Center, XXI Century, Mexican Institute of Social Security, Mexico City 06720, Mexico; (J.D.L.-E.); (M.G.L.-Z.)
| | - Alma Griselda Ramírez-Reyes
- Neurosurgery Department, Pediatric Hospital, National Medical Center, XXI Century, Mexican Institute of Social Security, Mexico City 06720, Mexico;
| | - María Guadalupe Miranda-Novales
- Analysis and Synthesis of Evidence Research Unit, National Medical Center, XXI Century, Mexican Institute of Social Security, Mexico City 06720, Mexico
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19
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Sipahi OR, Akyol D, Ormen B, Cicek-Senturk G, Mermer S, Onal U, Amer F, Saed MA, Ozdemir K, Tukenmez-Tigen E, Oztoprak N, Altin U, Kurtaran B, Popescu CP, Sakci M, Suntur BM, Gautam V, Sharma M, Kaya S, Akcil EF, Kaya S, Turunc T, Ergen P, Kandemir O, Cesur S, Bardak-Ozcem S, Ozgiray E, Yurtseven T, Erdem HA, Sipahi H, Arda B, Pullukcu H, Tasbakan M, Yamazhan T, Aydemir S, Ulusoy S. Empirical cefepime+vancomycin versus ceftazidime+vancomycin versus meropenem+vancomycin in the treatment of healthcare-associated meningitis: results of the multicenter ephesus study. BMC Infect Dis 2023; 23:639. [PMID: 37770836 PMCID: PMC10540455 DOI: 10.1186/s12879-023-08596-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/11/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Herein, we analyzed the efficacy of main antibiotic therapy regimens in the treatment of healthcare-associated meningitis (HCAM). MATERIALS/METHODS This retrospective cohort study was conducted in 18 tertiary-care academic hospitals Turkey, India, Egypt and Romania. We extracted data and outcomes of all patients with post-neurosurgical meningitis cases fulfilling the study inclusion criteria and treated with empirical therapy between December 2006-September 2018. RESULTS Twenty patients in the cefepime + vancomycin-(CV) group, 31 patients in the ceftazidime + vancomycin-(CFV) group, and 119 patients in the meropenem + vancomycin-(MV) group met the inclusion criteria. The MV subgroup had a significantly higher mean Glasgow Coma Score, a higher rate of admission to the intensive care unit within the previous month, and a higher rate of antibiot herapy within the previous month before the meningitis episode (p < 0.05). Microbiological success on Day 3-5, end of treatment (EOT) clinical success (80% vs. 54.8%% vs 57.9%), and overall success (EOT success followed by one-month survival without relapse or reinfection 65% vs. 51.6% vs. 45.3%), EOT all cause mortality (ACM) and day 30 ACM (15% vs. 22.6% vs. 26%) did not differ significantly (p > 0.05) among the three cohorts. No regimen was effective against carbapenem-resistant bacteria, and vancomycin resulted in an EOT clinical success rate of 60.6% in the methicillin-resistant staphylococci or ampicillin-resistant enterococci subgroup (n = 34). CONCLUSIONS Our study showed no significant difference in terms of clinical success and mortality among the three treatment options. All regimens were ineffective against carbapenem-resistant bacteria. Vancomycin was unsuccessful in approximately 40% of cases involving methicillin-resistant staphylococci or ampicillin-resistant enterococci.
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Affiliation(s)
- Oguz Resat Sipahi
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey
- Department of Infectious Diseases, Bahrain Oncology Center, King Hamad University Hospital, Muharraq, Bahrain
| | - Deniz Akyol
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey.
- Infectious Diseases Clinic, Kagizman State Hospital, Kagizman, Kars, Turkey.
| | - Bahar Ormen
- Infectious Diseases and Clinical Microbiology Clinic, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Gonul Cicek-Senturk
- Infectious Diseases and Clinical Microbiology Clinic, SB Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Sinan Mermer
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ekonomi University, Izmir, Turkey
| | - Ugur Onal
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | | | | | - Kevser Ozdemir
- Department of Infectious Diseases and Clinical Microbiology, Pamukkale University, Denizli, Turkey
| | - Elif Tukenmez-Tigen
- Department of Infectious Diseases and Clinical Microbiology, Marmara University, Istanbul, Turkey
| | - Nefise Oztoprak
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Uludag University, Bursa, Turkey
- Infectious Diseases and Clinical Microbiology Clinic, Antalya Education and Research Hospital, Antalya, Turkey
| | - Ummugulsum Altin
- Infectious Diseases and Clinical Microbiology Clinic, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Behice Kurtaran
- Department of Infectious Diseases and Clinical Microbiology, Cukurova University, Adana, Turkey
| | - Corneliu Petru Popescu
- Dr Victor Babes Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania
| | - Mustafa Sakci
- Medical Student, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Bedia Mutay Suntur
- Infectious Diseases and Clinical Microbiology Clinic, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Vikas Gautam
- Post-Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Megha Sharma
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Bilaspur, Himachal Pradesh, India
| | - Safak Kaya
- Infectious Diseases and Clinical Microbiology Clinic, Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Eren Fatma Akcil
- Department of Anaesthesiology and Reanimation, Istanbul University, Istanbul, Turkey
| | - Selcuk Kaya
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Karadeniz Technical University, Trabzon, Turkey
| | - Tuba Turunc
- Department of Infectious Diseases and Clinical Microbiology, Baskent University, Adana, Turkey
| | - Pınar Ergen
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University, Goztepe Educational and Research Hospital, Istanbul, Turkey
| | - Ozlem Kandemir
- Department of Infectious Diseases and Clinical Microbiology, Mersin University School of Medicine, Mersin, Turkey
| | - Salih Cesur
- Infectious Diseases and Clinical Microbiology Clinic, Ankara Training Hospital, Ankara, Turkey
| | - Selin Bardak-Ozcem
- Department of Infectious Diseases and Clinical Microbiology, Dr. Burhan Nalbantoğlu State Hospital, Nicosia, Northern Cyprus
| | - Erkin Ozgiray
- Department of Neurosurgery, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Taskın Yurtseven
- Department of Neurosurgery, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Huseyin Aytac Erdem
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | | | - Bilgin Arda
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Hüsnü Pullukcu
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Meltem Tasbakan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Tansu Yamazhan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Sohret Aydemir
- Department of Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Sercan Ulusoy
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey
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Yang X, Guo C, Wu G, Zhao K, Xiang D, Xu D, Liu D, He Y. Treatment of Central Nervous System Infection Caused by Multidrug-Resistant Acinetobacter baumannii with Intravenous and Intraventricular Colistin Sulfate: A Case Report and Literature Review. Infect Drug Resist 2023; 16:6029-6038. [PMID: 37719653 PMCID: PMC10503561 DOI: 10.2147/idr.s425415] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 09/05/2023] [Indexed: 09/19/2023] Open
Abstract
Purpose Due to the spread of antimicrobial-resistant bacteria and poor penetration of many antimicrobial drugs across the blood-brain barrier following intravenous administration, treatment of central nervous system (CNS) infections is challenging, especially infections caused by carbapenem-resistant organisms (CRO). Intraventricular (IVT) infusion of antimicrobial drugs could be a choice. This report aims to describe a patient with CNS infection caused by carbapenem-resistant Acinetobacter baumannii (CRAB) which was successfully treated with IVT combined with intravenous (IV) colistin sulfate. Methods A case of CNS infection caused by CRAB after a craniocerebral injury was presented. The patient was treated with IVT together with IV colistin sulfate. Moreover, literature on the regimens and safety of colistin sulfate were also reviewed and summarized. Results Intraventricular (50,000 U, qd/100,000 U, qd) combined with IV (500,000 U, q12h/500,000 U, q8h) colistin sulfate was given to the patient, and the CNS infection was successfully controlled. The patient was finally transferred back to a local hospital for rehabilitation treatment. No nephrotoxicity or neurotoxicity was observed during the therapy. Conclusion IV combined with IVT colistin sulfate is effective in the treatment of CNS infections caused by CRAB. IVT concomitant IV colistin sulfate might be a therapeutic option worth considering in the treatment of CNS infections caused by CRO.
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Affiliation(s)
- Xueping Yang
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People’s Republic of China
- Department of Pharmacy, Jingzhou Hospital of Traditional Chinese Medicine, Jingzhou, 434000, People’s Republic of China
| | - Changhong Guo
- Department of Scientific Education, Jingzhou Hospital of Traditional Chinese Medicine, Jingzhou, 434000, People’s Republic of China
| | - Guangjie Wu
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People’s Republic of China
| | - Kai Zhao
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People’s Republic of China
| | - Dong Xiang
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People’s Republic of China
| | - Dong Xu
- Department of Infection Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People’s Republic of China
| | - Dong Liu
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People’s Republic of China
| | - Yan He
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People’s Republic of China
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21
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Akram Asif A, Mahmood K, Riaz S, McHugh T, Sultan S. Bacterial ventriculoperitoneal shunt infections: changing trends in antimicrobial susceptibility, a 7-year retrospective study from Pakistan. Antimicrob Resist Infect Control 2023; 12:75. [PMID: 37553715 PMCID: PMC10408103 DOI: 10.1186/s13756-023-01283-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 07/27/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Ventriculoperitoneal (VP) shunt infections in adults represent a severe complication and make treatment more challenging. Therefore, drug susceptibility patterns are crucial for therapeutic decisions and infection control in neurosurgical centers. This 7-year retrospective study aimed to identify the bacteria responsible for adult VP shunt infections and determine their drug susceptibility patterns. METHODS This single-center study was performed from 2015 to 2021 in Lahore, Pakistan, and included CSF cultures from VP shunt infections. Demographic data, causative organisms, and antimicrobial susceptibility testing results were collected. Multivariate analysis of variance (MANOVA) and two-sample t-tests were used to analyze and compare the antibiotic sensitivity trends over the study period. RESULTS 14,473 isolates recovered from 13,937 CSF samples of VP shunt infections were identified and analyzed for their susceptibility patterns to antimicrobials. The proportion of Gram-negative and Gram-positive bacteria were 11,030 (76%) and 3443 (24)%, respectively. The predominant bacteria were Acinetobacter species (n = 5898, 41%), followed by Pseudomonas species (n = 2368, 16%) and coagulase-negative Staphylococcus (CoNS) (n = 1880, 13%). 100% of Staphylococcus aureus (S.aureus) and CoNS were sensitive to vancomycin and linezolid (n = 2580). However, 52% of S. aureus (719/1,343) were methicillin-resistant Staphylococcus aureus (MRSA). Acinetobacter showed maximum sensitivity to meropenem at 69% (2759/4768). Pseudomonas was 80% (1385/1863 sensitive to piperacillin-tazobactam, Escherichia coli (E. coli) showed 72% to amikacin (748/1055), while Klebsiella spp. was 57% (574/1170) sensitive to piperacillin-tazobactam. The sensitivity of piperacillin-tazobactam and meropenem for Gram-negative bacteria decreased significantly (p < 0.05) over 7 years, with 92.2% and 88.91% sensitive in 2015 and 66.7% and 62.8% sensitive in 2021, respectively. CONCLUSION The significant decrease in the effectiveness of carbapenem and beta-lactam/beta-lactamase inhibitor combination drugs for the common Gram-negative causative agents of VP shunt infections suggests that alternative antibiotics such as colistin, fosfomycin, ceftazidime/avibactam, ceftolozane/tazobactam, and tigecycline should be considered and in consequence included in testing panels. Additionally, it is recommended to adopt care bundles for the prevention of VP shunt infection.
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Affiliation(s)
- Amina Akram Asif
- University of the Punjab, Lahore, Pakistan.
- Lahore General Hospital, Punjab Institute of Neurosciences, Lahore, Pakistan.
| | - Khalid Mahmood
- Lahore General Hospital, Punjab Institute of Neurosciences, Lahore, Pakistan
| | - Saba Riaz
- University of the Punjab, Lahore, Pakistan
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22
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Li C, Zhou P, Liu Y, Zhang L. Treatment of Ventriculitis and Meningitis After Neurosurgery Caused by Carbapenem-Resistant Enterobacteriaceae (CRE): A Challenging Topic. Infect Drug Resist 2023; 16:3807-3818. [PMID: 37342434 PMCID: PMC10278654 DOI: 10.2147/idr.s416948] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/08/2023] [Indexed: 06/22/2023] Open
Abstract
Post-neurosurgical infection is a common complication of neurosurgery, and serious infection can threaten the life of patients. In recent years, the increase in multidrug-resistant bacteria, especially carbapenem-resistant Enterobacteriaceae (CRE), has proved fatal to patients. Although there are a few cases of CRE meningitis and few clinical trials have been carried out, it has attracted increasing attention with the increasing probability of its occurrence, especially considering that there are few successful cases. An increasing number of studies are also looking for the risk factors and clinical symptoms of CRE intracranial infection. In terms of treatment, some new antibiotics are gradually being used in the clinic, but due to the complicated drug-resistant mechanism of CRE and the obstruction of the blood‒brain barrier (BBB), the therapeutic effect is still very poor. In addition, obstructive hydrocephalus and brain abscess caused by CRE meningitis are still important causes of patient death and are also difficult to treat.
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Affiliation(s)
- Cuiling Li
- Department of Neurosurgery, Shandong Medicine and Health Key Laboratory of Neurosurgery, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, People’s Republic of China
| | - Peng Zhou
- Department of Neurosurgery, Shandong Medicine and Health Key Laboratory of Neurosurgery, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, People’s Republic of China
| | - Yuanqin Liu
- Department of Neurosurgery, Shandong Medicine and Health Key Laboratory of Neurosurgery, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, People’s Republic of China
| | - Lei Zhang
- Department of Neurosurgery, Shandong Medicine and Health Key Laboratory of Neurosurgery, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, People’s Republic of China
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23
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König C, Martens-Lobenhoffer J, Czorlich P, Westphal M, Bode-Böger SM, Kluge S, Grensemann J. Cerebrospinal fluid penetration of fosfomycin in patients with ventriculitis: an observational study. Ann Clin Microbiol Antimicrob 2023; 22:29. [PMID: 37095559 PMCID: PMC10127017 DOI: 10.1186/s12941-023-00572-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 03/12/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND For treatment of ventriculitis, vancomycin and meropenem are frequently used as empiric treatment but cerebrospinal fluid (CSF) penetration is highly variable and may result in subtherapeutic concentrations. Fosfomycin has been suggested for combination antibiotic therapy, but data are sparse, so far. Therefore, we studied CSF penetration of fosfomycin in ventriculitis. METHODS Adult patients receiving a continuous infusion of fosfomycin (1 g/h) for the treatment of ventriculitis were included. Routine therapeutic drug monitoring (TDM) of fosfomycin in serum and CSF was performed with subsequent dose adaptions. Demographic and routine laboratory data including serum and CSF concentrations for fosfomycin were collected. Antibiotic CSF penetration ratio as well as basic pharmacokinetic parameters were investigated. RESULTS Seventeen patients with 43 CSF/serum pairs were included. Median fosfomycin serum concentration was 200 [159-289] mg/L and the CSF concentration 99 [66-144] mg/L. Considering only the first measurements in each patient before a possible dose adaption, serum and CSF concentrations were 209 [163-438] mg/L and 104 [65-269] mg/L. Median CSF penetration was 46 [36-59]% resulting in 98% of CSF levels above the susceptibility breakpoint of 32 mg/L. CONCLUSION Penetration of fosfomycin into the CSF is high, reliably leading to appropriate concentrations for the treatment of gram positive and negative bacteria. Moreover, continuous administration of fosfomycin appears to be a reasonable approach for antibiotic combination therapy in patients suffering from ventriculitis. Further studies are needed to evaluate the impact on outcome parameters.
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Affiliation(s)
- Christina König
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Hospital Pharmacy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Jens Martens-Lobenhoffer
- Institute of Clinical Pharmacology, Otto-Von-Guericke University, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Patrick Czorlich
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Stefanie M Bode-Böger
- Institute of Clinical Pharmacology, Otto-Von-Guericke University, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Jörn Grensemann
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
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Jiang LZ, Shen Y, Liang F, Ye XM, Chen J, Yu YM. Intracranial Myroides odoratimimus Infection After EVD Successfully Treated with Intravenous Plus Intraventricular Tigecycline: A Case Report. Infect Drug Resist 2023; 16:1955-1963. [PMID: 37034395 PMCID: PMC10075215 DOI: 10.2147/idr.s403088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/16/2023] [Indexed: 04/03/2023] Open
Abstract
Intracranial infections are the most serious and common postoperative complications with significant mortality and morbidity. Myroides odoratimimus (M. odoratimimus), a Gram-negative environmental species and an opportunistic microorganism, predominantly infects immunocompromised individuals. Limited clinical experiences and documented multidrug resistance have resulted in a scarcity of data on the treatment of M. odoratimimus infections. As far as we know, this is the first reported case of an intracranial M. odoratimimus infection with external ventricular drains (EVD) that was effectively treated with a combination of intravenous and intraventricular tigecycline in an immunocompetent adult host.
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Affiliation(s)
- Ling-Zhi Jiang
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of China
| | - Ye Shen
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of China
| | - Feng Liang
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of China
| | - Xiang-Ming Ye
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of China
- Correspondence: Xiang-Ming Ye, Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of China, Tel +86-13750814756, Email
| | - Jing Chen
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of China
| | - Yan-Mei Yu
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of China
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Zeggay A, Patry I, Chirouze C, Bouiller K. Characteristics and outcomes of cerebrospinal fluid shunt and drain-associated infections. Infect Dis Now 2023; 53:104665. [PMID: 36736666 DOI: 10.1016/j.idnow.2023.104665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/11/2023] [Accepted: 01/24/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Data on infections associated with cerebrospinal fluid shunt (CSF-S) or device-associated infection (CSF-SDI) are limited in adults. We performed a retrospective study to describe characteristics, management, and outcome of CSF-SDI. METHODS All patients with CSF-SDI and admitted to our institution from January 2013 to December 2019 were included. RESULTS Among 50 patients, fifty-six episodes of CSF-SDI (41 external ventricular device-associated infections (CSF-D) and 15 other shunt infections (CSF-S) were included. The incidence of CSF-SDI was 11.9 %. Fever was the most common symptom (81 %). Enterobacterales were more prevalent in CSF-S than in CSF-D (20 % vs 53 %, p = 0.02). As regards CSF-D, deceased patients (11/41, 27 %) more frequently had a Glasgow coma scale score decreasing from baseline (p < 0.01), lower glycorrhachia (p < 0.01), a higher protein level in CSF (p = 0.001) and a positive control CSF culture (p = 0.031). CONCLUSIONS CSF-SDIs are rare but with a high mortality rate. Mortality was more closely related to the infection than to comorbidities or underlying neurosurgical disease. A second CSF analysis significantly helped to detect patients with CSF-D with a poor prognosis.
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Affiliation(s)
- Abdeljalil Zeggay
- Department of infectious and tropical diseases, CHRU Besançon, Besançon, France.
| | - Isabelle Patry
- Laboratory of microbiology, CHRU Besançon, Besançon, France
| | - Catherine Chirouze
- Department of infectious and tropical diseases, CHRU Besançon, Besançon, France; UMR CNRS 6249 Chrono-Environnement, University of Bourgogne Franche-Comté, Besançon, France
| | - Kevin Bouiller
- Department of infectious and tropical diseases, CHRU Besançon, Besançon, France; UMR CNRS 6249 Chrono-Environnement, University of Bourgogne Franche-Comté, Besançon, France
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Liang S, Wang Z, Wu P, Chen Z, Yang X, Li Y, Ren X, Zhang D, Ge Z. Risk Factors and Outcomes of Central Nervous System Infection After Spinal Surgery: A Retrospective Cohort Study. World Neurosurg 2023; 170:e170-e179. [PMID: 36328166 DOI: 10.1016/j.wneu.2022.10.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate the risk factor associated with central nervous system infection, a rare and dire complication after spinal surgery. METHODS Univariate and multivariate logistic regression analyses were performed to screen for the independent risk factors. According to the different administration methods of antibiotics, patients were divided into intravenous and intrathecal groups. The differences in time needed for body temperature, white blood cells (WBC), and C-reactive protein (CRP) to return to normal and the time of antibiotic application were compared between the 2 groups. In addition, the differences in WBC, neutrophil ratio, CRP, procalcitonin in blood, and WBC in cerebrospinal fluid were compared before intrathecal injection, after the first one, and the last one. The incidence of complications in the 2 groups was observed. RESULTS Dural tears, laminectomy, and operation time >3 hours were identified as independent risk factors. The time needed for body temperature, WBC, and CRP to return to normal and the antibiotic application time were significantly different between the 2 groups (all P < 0.05). Before and after the first intrathecal injection and after the last intrathecal injection, the differences in WBCs, neutrophil ratios, CRP, procalcitonin in blood, and cerebrospinal fluid-WBC were statistically significant in overall and pairwise comparisons (P < 0.05). Complications occurred in 2 and 14 cases, respectively. CONCLUSIONS The independent risk factors for central nervous system infection after spinal surgery were a dural tear, laminectomy, and operation time > 3 hours. Combined intravenous and intrathecal injections of antibiotics led to a better effect than intravenous injection alone; however, this approach was associated with more complications.
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Affiliation(s)
- Simin Liang
- Department of Orthopaedics, General Hospital of Ningxia Medical University, Yinchuan City of Ningxia, China
| | - Zhiqiang Wang
- Department of Orthopaedics, General Hospital of Ningxia Medical University, Yinchuan City of Ningxia, China
| | - Peng Wu
- Department of Orthopaedics, General Hospital of Ningxia Medical University, Yinchuan City of Ningxia, China
| | - Zhen Chen
- Department of Orthopaedics, General Hospital of Ningxia Medical University, Yinchuan City of Ningxia, China
| | - Xiaoyan Yang
- Medical Laboratory Center, General Hospital of Ningxia Medical University, Yinchuan City of Ningxia, China
| | - Ying Li
- Medical Record Room, General Hospital of Ningxia Medical University, Yinchuan City of Ningxia, China
| | - Xiaolu Ren
- Department of Radiology, General Hospital of Ningxia Medical University, Yinchuan City of Ningxia, China
| | - Danmei Zhang
- Department of Nosocomial Infection, General Hospital of Ningxia Medical University, Yinchuan City of Ningxia, China
| | - Zhaohui Ge
- Department of Orthopaedics, General Hospital of Ningxia Medical University, Yinchuan City of Ningxia, China.
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Treatment of Central Nervous System Infection Caused by Multidrug-Resistant Klebsiella pneumoniae with Colistin Sulfate Intravenously and Intrathecally: A Case Report. Pharmaceuticals (Basel) 2022; 15:ph15121482. [PMID: 36558933 PMCID: PMC9787966 DOI: 10.3390/ph15121482] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 11/26/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Due to the blood-brain barrier and limited antibiotic choices, polymyxin is currently the first-line agent for the treatment of central nervous system infections (CNSIs) caused by multidrug-resistant Gram-negative bacteria (MDR-GNB). Colistin sulfate, as a polymyxin E different from CMS, is used in Chinese clinics, and there are limited reports on its use in the treatment of CNSIs. Case Presentation: This case describes a 76-year-old man who underwent complex neurosurgery for cervical spinal stenosis. Postoperatively, the patient developed a fever and a poorly healed surgical wound. Numerous blood routine tests, inflammatory markers, pathogenic tests of cervical secretions, cerebrospinal fluid (CSF), and sputum were sent for diagnosis. After empirical antimicrobial treatments failed, the CSF and wound pus cultured carbapenem-resistant Klebsiella pneumoniae. The regimen was adjusted to colistin sulfate intravenously and intrathecal injection combined with tigecycline. In addition, the management of infection foci, including continuous lumbar pool drain, cervical 3-5 internal fixation removal with cervical 1-6 spine dilation, CSF leak repair, and right thigh broad fasciotomy, were performed. After treatment, the patient was discharged with multiple sets of negative CSF cultures and the infection under control. Conclusions: For CNSIs caused by MDR-GNB, the selection of colistin sulfate for intravenous and topical combination treatment is a viable choice.
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Abstract
PURPOSE OF REVIEW The aim of this review is to provide a practical and updated summary on healthcare-associated central nervous system infections and their management. RECENT FINDINGS The term 'healthcare-associated ventriculitis and meningitis' has recently been coined and clinical practical guidelines have been published on the management of these nosocomial infections. Many aspects have still to be further investigated (e.g. cerebrospinal fluid biomarkers, indications for novel antibiotics, intrathecal antimicrobial regimens). SUMMARY Clinicians should maintain a high index of suspicion for healthcare-associated central nervous system infections in patients with specific risk factors (i.e. recent neurosurgery, cerebrospinal shunts, drains or implantable devices, head/spinal traumatic events), taking into account systemic signs, and alterations in microbiological, imaging, cerebrospinal fluid findings. The diagnosis is often difficult to confirm because of reduced levels of consciousness or coma. Both Gram-positive and Gram-negative (often multidrug-resistant or even pandrug-resistant) microorganisms may be the cause. Selection of antibiotics must consider susceptibility and penetration into the central nervous system. Ineffective treatments are frequent, and mortality can reach 60%. Future research should focus on the diagnostic performance of biomarkers and on the use of novel antimicrobial regimens, especially for the treatment of difficult to treat infections.
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Li J, Liu Y, Wu G, Wang H, Xu X. Intravenous plus intraventricular tigecycline-amikacin therapy for the treatment of carbapenem-resistant Klebsiella pneumoniae ventriculitis: A case report. Medicine (Baltimore) 2022; 101:e29635. [PMID: 35905241 PMCID: PMC9333527 DOI: 10.1097/md.0000000000029635] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Central nervous system infections (CNSIs) are one of the most serious complications after neurosurgery, especially carbapenem-resistant bacterial meningitis. Owing to the poor blood-brain barrier permeability of most antibiotics, the treatment of CNSIs by intraventricular (IVT) administration is becoming a hot topic in clinical research. Currently, the treatment of CNSIs caused by carbapenem-resistant Klebsiella pneumoniae is mainly based on intraventricular injection of an antibiotic combined with one or more other systemic intravenous (IV) antibiotics, whereas there are few case reports of intraventricular injection of 2 antibiotics. PATIENT CONCERNS A 57-year-old man with an open craniocerebral injury presented with dyspnea, high fever, and seizures associated with surgery. DIAGNOSIS Intracranial infection caused by carbapenem-resistant K. pneumoniae was diagnosed. INTERVENTIONS On the advice of a clinical pharmacist, the patient was given tigecycline (100 mg IV + 3 mg IVT q12h) combined with amikacin (0.8 g IV + 30 mg IVT qd) antiinfective therapy. Ultimately, the pathogens in the cerebrospinal fluid were eradicated after 7 days, and the CNSIs were completely cured after 14 days. OUTCOMES The patient recovered and was discharged from the hospital without adverse reactions. LESSONS A series of in vitro and in vivo synergy tests of carbapenem-resistant K. pneumoniae showed that tigecycline combined with aminoglycosides had good synergistic effects and effectively suppressed bacterial resistance selection. Intravenous plus intraventricular tigecycline-amikacin seems to be a safe and effective treatment option for carbapenem-resistant K. pneumoniae CNSIs.
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Affiliation(s)
- Jiyao Li
- Department of Pharmacy, Liaocheng People’s Hospital, Liaocheng, China
- *Correspondence: Jiyao Li, Department of Pharmacy, Liaocheng People’s Hospital, Liaocheng, Shangdong, China (e-mail: )
| | - Yiguo Liu
- Department of Pharmacy, Liaocheng People’s Hospital, Liaocheng, China
| | - Guangtao Wu
- Department of Pharmacy, Liaocheng People’s Hospital, Liaocheng, China
| | - Hongyan Wang
- Department of Pharmacy, Liaocheng People’s Hospital, Liaocheng, China
| | - Xiaoyan Xu
- Department of Pharmacy, Liaocheng People’s Hospital, Liaocheng, China
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Fu P, Zhang Y, Zhang J, Hu J, Sun Y. Prediction of Intracranial Infection in Patients under External Ventricular Drainage and Neurological Intensive Care: A Multicenter Retrospective Cohort Study. J Clin Med 2022; 11:jcm11143973. [PMID: 35887741 PMCID: PMC9317602 DOI: 10.3390/jcm11143973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/23/2022] [Accepted: 07/05/2022] [Indexed: 12/02/2022] Open
Abstract
Objective: To generate an optimal prediction model along with identifying major contributors to intracranial infection among patients under external ventricular drainage and neurological intensive care. Methods: A retrospective cohort study was conducted among patients admitted into neurointensive care units between 1 January 2015 and 31 December 2020 who underwent external ventricular drainage due to traumatic brain injury, hydrocephalus, and nonaneurysmal spontaneous intracranial hemorrhage. Multivariate logistic regression in combination with the least absolute shrinkage and selection operator regression was applied to derive prediction models and optimize variable selections. Other machine-learning algorithms, including the support vector machine and K-nearest neighbor, were also applied to derive alternative prediction models. Five-fold cross-validation was used to train and validate each model. Model performance was assessed by calibration plots, receiver operating characteristic curves, and decision curves. A nomogram analysis was developed to explicate the weights of selected features for the optimal model. Results: Multivariate logistic regression showed the best performance among the three tested models with an area under curve of 0.846 ± 0.006. Six variables, including hemoglobin, albumin, length of operation time, American Society of Anesthesiologists grades, presence of traumatic subarachnoid hemorrhage, and a history of diabetes, were selected from 37 variable candidates as the top-weighted prediction features. The decision curve analysis showed that the nomogram could be applied clinically when the risk threshold is between 20% and 100%. Conclusions: The occurrence of external ventricular-drainage-associated intracranial infections could be predicted using optimal models and feature-selection approaches, which would be helpful for the prevention and treatment of this complication in neurointensive care units.
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Affiliation(s)
- Pengfei Fu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China; (P.F.); (J.Z.)
| | - Yi Zhang
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation Ministry of Education, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China;
| | - Jun Zhang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China; (P.F.); (J.Z.)
| | - Jin Hu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China; (P.F.); (J.Z.)
- Correspondence: (J.H.); (Y.S.); Tel.: +86-173-1782-1354 (J.H.); +86-134-7275-5168 (Y.S.)
| | - Yirui Sun
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China; (P.F.); (J.Z.)
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai 200040, China
- National Center for Neurological Disorders, Shanghai 200031, China
- Correspondence: (J.H.); (Y.S.); Tel.: +86-173-1782-1354 (J.H.); +86-134-7275-5168 (Y.S.)
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