Efficacy of intravenous plus intrathecal/intracerebral ventricle injection of polymyxin B for post-neurosurgical intracranial infections due to MDR/XDR Acinectobacter baumannii: a retrospective cohort study.
Efficacy of intravenous plus intrathecal/intracerebral ventricle injection of polymyxin B for post-neurosurgical intracranial infections due to MDR/XDR Acinectobacter baumannii: a retrospective cohort study.
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静脉内加鞘内/脑室内注射多粘菌素 B 对 MDR/XDR 鲍曼不动杆菌引起的神经外科术后颅内感染的疗效：一项回顾性队列研究
DOI：
10.1186/s13756-018-0305-5
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发表时间：
2018
影响因子：
5.5
通讯作者：
Zhang G
中科院分区：
文献类型：
--
作者：
Pan S;Huang X;Wang Y;Li L;Zhao C;Yao Z;Cui W;Zhang G
背景由多重耐药或广泛耐药的鲍曼不动杆菌引起的神经外科术后颅内感染治疗困难，死亡率高。方法回顾分析2013年1月至2017年9月在浙江大学医学院附属第二医院(杭州，中国)进行的61例脑脊液培养多药耐药或广泛耐药的脑脊液培养阳性患者的临床资料。鲍曼尼在神经外科手术后。鞘内/脑室内注射多粘菌素B组为鞘内/脑室内注射组，鞘内/脑室内注射多粘菌素B组为鞘内/脑室内注射组，鞘内/脑室内注射组为静脉组。收集临床资料、治疗病史、脑脊液常规及生化指标、临床疗效、微生物清除率、28d病死率等资料进行分析。本院神经外科手术后发生颅内感染的患者中鲍曼不动杆菌感染率为33.64%。分离株A。鲍曼不动杆菌对多种抗生素耐药，最严重的是碳青霉烯类(对亚胺培南和美罗培南耐药率为100.00%)、头孢菌素类(对头孢唑林耐药率为98.38%、头孢他啶耐药率为100.00%、头孢曲松耐药率为100.00%、头孢吡肟耐药率为98.39%)。然而，分离到的A。鲍曼不动杆菌对多粘菌素B完全敏感(敏感率为100.00%)，其次为替吉环素(60.66%)和阿米卡星(49.18%)。两组基本临床资料差异无统计学意义。与静脉组相比，鞘内/脑室内注射组28d病死率(55.26%vs.8.70%，P= .01)显著降低，临床有效率(95.65%vs.23.68%，P<； 0.001)和微生物清除率(91.30%vs.18.42%，P<； 0.001)显著高于静脉组(P<0.05)。鲍曼尼。
BackgroundPost-neurosurgical intracranial infections caused by multidrug-resistant or extensively drug-resistantAcinetobacter baumanniiare difficult to treat and associated with high mortality. In this study, we analyzed the therapeutic efficacy of intravenous combined with intrathecal/intracerebral ventricle injection of polymyxin B for this type of intracranial infection.MethodsThis retrospective study was conducted from January 2013 to September 2017 at the Second Affiliated Hospital, Zhejiang University School of Medicine (Hangzhou,China) and included 61 cases for which cerebrospinal fluid (CSF) cultures were positive for multidrug-resistant or extensively drug-resistantA. baumanniiafter a neurosurgical operation. Patients treated with intravenous and intrathecal/intracerebral ventricle injection of polymyxin B were assigned to the intrathecal/intracerebral group, and patients treated with other antibiotics without intrathecal/intracerebral injection were assigned to the intravenous group. Data for general information, treatment history, and the results of routine tests and biochemistry indicators in CSF, clinical efficiency, microbiological clearance rate, and the 28-day mortality were collected and analyzed.ResultsThe rate of multidrug-resistant or extensively drug-resistantA. baumanniiinfection among patients who experienced an intracranial infection after a neurosurgical operation was 33.64% in our hospital. The isolatedA. baumanniiwere resistant to various antibiotics, and most seriously to carbapenems (100.00% resistance rate to imipenem and meropenem), cephalosporins (resistance rates of 98.38% to cefazolin, 100.00% to ceftazidime, 100.00% to cefatriaxone, and 98.39% to cefepime). However, the isolatedA. baumanniiwere completely sensitive to polymyxin B (sensitivity rate of 100.00%), followed by tigecycline (60.66%) and amikacin (49.18%). No significant differences in basic clinical data were observed between the two groups. Compared with the intravenous group, the intrathecal/intracerebral group had a significantly lower 28-day mortality (55.26% vs. 8.70%,P= 0.01) and higher rates of clinical efficacy and microbiological clearance (95.65% vs. 23.68%,P< 0.001; 91.30% vs. 18.42%,P< 0.001, respectively).ConclusionsIntravenous plus intrathecal/intracerebral ventricle injection of polymyxin B is an effective regimen for treating intracranial infections caused by multidrug-resistant or extensively drug-resistantA. baumannii.
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影响因子：
5.2
作者：
Guardado, A. Rodriguez;Blanco, A.;Carton, J. A.
通讯作者：
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Falagas, ME