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Alhazmi AH, Alameer KM, Abuageelah BM, Gharawi AY, Hakami EF, Zogel TA, Almalki AJ, Magrashi EG, Alharbi WA, Manni RM, Buayti AA, Alharbi AA, Dhayhi NS, Haddad M. Epidemiology and antimicrobial resistance patterns of bacterial meningitis among hospitalized patients at a tertiary care hospital in Saudi Arabia: a six-year retrospective study. Eur J Clin Microbiol Infect Dis 2024:10.1007/s10096-024-04835-6. [PMID: 38683272 DOI: 10.1007/s10096-024-04835-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 04/22/2024] [Indexed: 05/01/2024]
Abstract
INTRODUCTION Bacterial meningitis poses significant medical challenges due to its acute inflammatory nature and potential for severe neurological complications, emphasizing the need for prompt diagnosis and treatment. Limited data exists on its epidemiology and antimicrobial resistance trends among hospitalized patients in Saudi Arabia. This study aimed to investigate these factors at a tertiary care hospital over six years. METHODS A retrospective analysis was conducted on cerebrospinal fluid samples results from 222 bacterial meningitis cases among hospitalized patients between 2018 and 2023. Demographic, clinical, microbiological data, and antibiotic susceptibility patterns were collected and analyzed. RESULTS Pseudomonas aeruginosa (43%) was the predominant pathogen isolated. Neonates (16%) and children (47%) were most affected population. Nosocomial meningitis accounted for 92% of cases, mainly in the intensive care settings (50.45%). Extended-spectrum beta-lactamase was the leading resistance pattern (12.2%). Seasonal variation was observed, with a peak incidence in October-November. CONCLUSION The study highlights the substantial burden of bacterial meningitis among hospitalized patients, especially among high-risk groups. Emerging antimicrobial resistance emphasizes the need for optimized surveillance and stewardship. Future prospective research employing molecular techniques across multiple centers in the country is warranted to enhance understanding and guide public health strategies in Saudi Arabia.
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Affiliation(s)
| | - Khalid M Alameer
- Faculty of Medicine, Jazan University, Jazan, 45142, Saudi Arabia
| | - Bandar M Abuageelah
- Department of Medicine and Surgery, Batterjee Medical College, Aseer, 62451, Saudi Arabia
| | | | | | - Taif Ali Zogel
- Faculty of Medicine, Jazan University, Jazan, 45142, Saudi Arabia
| | | | | | - Wafa Ali Alharbi
- Faculty of Medicine, Jazan University, Jazan, 45142, Saudi Arabia
| | | | | | - Ahmad A Alharbi
- Faculty of Medicine, Jazan University, Jazan, 45142, Saudi Arabia
| | - Nabil S Dhayhi
- King Fahad Central Hospital, Ministry of Health, Jazan, 45142, Saudi Arabia
| | - Moayad Haddad
- King Fahad Central Hospital, Ministry of Health, Jazan, 45142, Saudi Arabia
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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] [What about the content of this article? (0)] [Affiliation(s)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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Goyal-Honavar A, Markose AP, Gupta A, Manesh A, Varghese GM, Rose W, Jonathan GE, Prabhu K, Chacko AG. Distinct patterns of postoperative fever in paediatric neurosurgery patients. Childs Nerv Syst 2024:10.1007/s00381-024-06355-2. [PMID: 38472391 DOI: 10.1007/s00381-024-06355-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/01/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE Postoperative fever is a common problem following neurosurgery but data on the causes among paediatric patients is sparse. In this report, we determined the incidence, causes, and outcomes of postoperative fever in paediatric neurosurgical patients (< 18 years), and contrasted the findings with an adult cohort published recently from our unit. METHODS We recruited 61 patients who underwent 73 surgeries for non-traumatic neurosurgical indications over 12 months. A standard protocol was followed for the evaluation and management of postoperative fever. We prospectively collected data pertaining to operative details, daily maximal temperature, clinical features, and use of surgical drains, urinary catheters, and other adjuncts. Elevated body temperature of > 99.9 °F or 37.7 °C for > 48 h or associated with clinical deterioration or localising features was considered as "fever"; elevated temperature not meeting these criteria was classified as transient elevation in temperature (TET). RESULTS Twenty-six patients (35.6%) had postoperative fever, more frequent than in adult patients. TET occurred in 12 patients (16.4%). The most common causes of fever were aseptic meningitis (34.6%), followed by urinary tract infections (15.4%), pyogenic meningitis, COVID-19, and wound infections. Postoperative fever was associated with significantly longer duration of hospital admission and was the commonest cause of readmission. CONCLUSION In contrast to adults, early temperature elevations in paediatric patients may portend infectious and serious non-infectious causes of fever, including delayed presentation with aseptic meningitis, a novel association among paediatric patients. Investigation guided by clinical assessment and conservative antibiotic policy in keeping with the institutional microbiological profile provides the most appropriate strategy in managing paediatric postoperative fever.
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Affiliation(s)
- Abhijit Goyal-Honavar
- Section of Neurosurgery, Department of Neurosciences, Christian Medical College, Vellore, 632004, Tamil Nadu, India
| | - Annsmol P Markose
- Section of Neurosurgery, Department of Neurosciences, Christian Medical College, Vellore, 632004, Tamil Nadu, India
| | - Ankush Gupta
- Section of Neurosurgery, Department of Neurosciences, Christian Medical College, Vellore, 632004, Tamil Nadu, India
| | - Abi Manesh
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - George M Varghese
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Winsley Rose
- Department of Paediatric Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Gandham Edmond Jonathan
- Section of Neurosurgery, Department of Neurosciences, Christian Medical College, Vellore, 632004, Tamil Nadu, India
| | - Krishna Prabhu
- Section of Neurosurgery, Department of Neurosciences, Christian Medical College, Vellore, 632004, Tamil Nadu, India.
| | - Ari G Chacko
- Section of Neurosurgery, Department of Neurosciences, Christian Medical College, Vellore, 632004, Tamil Nadu, India
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García-Sánchez C, Bloise I, García-Rodríguez J, Cendejas-Bueno E. Are cerebrospinal fluid biochemical parameters valid to predict positive results in microbiological molecular diagnostic platforms? A 4-year experience with the FilmArray® Panel Meningitis/Encephalitis for detection of community-acquired bacterial meningitis. Diagn Microbiol Infect Dis 2023; 107:116031. [PMID: 37595339 DOI: 10.1016/j.diagmicrobio.2023.116031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 07/10/2023] [Accepted: 07/15/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVE To demonstrate whether the use of the FilmArray® Meningitis/Encephalitis panel (M/E) in the diagnosis of bacterial meningitis can be optimized based on the screening of cerebrospinal fluid biochemical parameters and whether there is a correlation between biochemical data and positive results of the technique. MATERIAL AND METHODS We used data from La Paz University Hospital between September 5, 2017 and December 1, 2021, from patients who had had the FilmArray® panel M/E performed on cerebrospinal fluid samples. RESULTS Bacterial meningitis was suspected in 63.9% of the patients; 38.15% had a positive result on the FilmArray® panel M/E, of which 68.97% were isolated in culture. Of the biochemical parameters studied in cerebrospinal fluid, white blood cell count, lactate, and protein were increased in PCR-positive patients, but glucose was decreased. DISCUSSION Only lactate showed a significant contribution to the model, with a cut-off point of 4.65 mmol/L with a sensitivity of 81.5% and a specificity of 96.4%.
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Affiliation(s)
| | - Iván Bloise
- Clinical Microbiology Department, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | | | - Emilio Cendejas-Bueno
- Clinical Microbiology Department, Hospital Universitario La Paz, IdiPaz, Madrid, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Yue Z, Zhi X, Bi L, Zhao L, Ji J. Treatment and prognostic risk factors for intracranial infection after craniocerebral surgery. Neurosurg Rev 2023; 46:199. [PMID: 37568062 DOI: 10.1007/s10143-023-02106-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023]
Abstract
The objective of this study was to determine risk factors of pejorative evolution course in patients suffering from postoperative cranial infection. The data of patients who developed an intracranial infection after craniocerebral surgery in the neurosurgical intensive care unit of the First Affiliated Hospital of Nanjing Medical University in Nanjing, Jiangsu, China, from February 2018 to August 2019 were retrospectively analyzed. Logistic regression was used to analyze the factors influencing the prognosis of intracranial infection treatment. Sixty-four patients developed an infection after craniocerebral surgery, and 48 of them with negative CSF cultures received experimental anti-infectives. In 16 patients, cerebrospinal fluid culture showed pandrug-resistant pathogens, including 11 Acinetobacter baumannii (11), Klebsiella pneumoniae (3), Escherichia coli (1), and Candida glabrata (1). Nine patients received intraventricular or intrathecal injections of polymyxin B. The mean duration of infection treatment was 22.2 ± 9.9 days, and the clinical cure rate was 85.9% (55/64). Logistic multivariate regression analysis showed that inadequate CSF drainage (OR, 6.839; 95% CI, 1.130-41.383; P = 0.036) and infection with drug-resistant bacteria (OR, 24.241; 95% CI, 2.032-289.150; P = 0.012) were independent risk factors for postoperative intracranial infection. Intracranial infection with positive CSF culture and inadequate CSF drainage are factors contributing to the poor prognosis of intracranial infection. Moreover, early anti-infection treatment and adequate CSF drainage may improve patient outcomes. In particular, intraventricular or intrathecal injection of polymyxin B may be a safe and effective treatment strategy for MDR/XDR gram-negative bacilli infection.
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Affiliation(s)
- Zhen Yue
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaohui Zhi
- Department of Rehabilitation, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Liqing Bi
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lin Zhao
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jing Ji
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
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Hönikl LS, Lange N, Meyer B, Gempt J, Meyer HS. Postoperative Communicating Hydrocephalus Following Grade 2/3 Glioma Resection: Incidence, Timing and Risk Factors. Cancers (Basel) 2023; 15:3548. [PMID: 37509211 PMCID: PMC10377207 DOI: 10.3390/cancers15143548] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND In diffusely infiltrating gliomas, the maximum extent of tumor resection is an important predictor of overall survival, irrespective of histological or molecular subtype or tumor grade. For glioblastoma WHO grade 4 (GBM), it has been shown that resection-related events, such as ventricular opening and ventriculitis, increase the risk for development of communicating hydrocephalus (CH) requiring cerebrospinal fluid (CSF) diversion surgery. Risk factors for the development and the incidence of hydrocephalus following resection of other types of infiltrating gliomas are less well established. In this study, we evaluated the incidence and timing of occurrence of different types of hydrocephalus and potential risk factors for the development of CH following resection of grade 2 and 3 gliomas. METHODS 346 patients who underwent tumor resection (WHO grade 2: 42.2%; 3: 57.8%) at our department between 2006 and 2019 were analyzed retrospectively. For each patient, age, sex, WHO grade, histological type, IDH mutation and 1p/19q codeletion status, tumor localization, number of resections, rebleeding, ventriculitis, ventricular opening during resection and postoperative CSF leak were determined. Uni- as well as multivariate analyses were performed to identify associations with CH and independent risk factors. RESULTS 24 out of 346 (6.9%) patients needed CSF diversion surgery (implantation of a ventriculoperitoneal or ventriculoatrial shunt) following resection. Nineteen patients (5.5%) had CH, on median, 44 days after the last resection (interquartile range: 18-89 days). Two patients had obstructive hydrocephalus (OH), and three patients had other CSF circulation disorders. CH was more frequent in grade 3 compared to grade 2 gliomas (8.5 vs. 1.4%). WHO grade 3 (odds ratio (OR) 7.5, p = 0.00468), rebleeding (OR 5.0, p = 0.00984), ventriculitis (OR 4.1, p = 0.00463) and infratentorial tumor localization (OR 6.6, p = 0.00300) were identified as significant independent risk factors for the development of post-resection CH. Ventricular opening was significantly associated with CH, but it was not an independent risk factor. CONCLUSION Physicians treating brain tumor patients should be aware that postoperative CH requiring CSF shunting occurs not only in GBM but also after resection of lower-grade gliomas, especially in grade 3 tumors. It usually occurs several weeks after resection. Rebleeding and postoperative ventriculitis are independent risk factors.
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Affiliation(s)
- Lisa S Hönikl
- Department of Neurosurgery, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Nicole Lange
- Department of Neurosurgery, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Jens Gempt
- Department of Neurosurgery, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Hanno S Meyer
- Department of Neurosurgery, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
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Cotran-Lenrow A, Tefera LS, Douglas-Vail M, Ayebare A, Kpokpah LN, Davis BP. Community-Acquired Pseudomonas aeruginosa Meningitis in a Pediatric Patient. Cureus 2023; 15:e42376. [PMID: 37621787 PMCID: PMC10445549 DOI: 10.7759/cureus.42376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
This case report presents a rare and significant case of community-acquired Pseudomonas aeruginosa meningitis in a healthy 13-month-old male patient in rural Liberia. Pseudomonas aeruginosa meningitis, particularly in the absence of predisposing factors, is a rare occurrence with a high mortality rate. The challenges in diagnosing this condition, especially in resource-limited settings, are highlighted. The patient initially presented with fever, seizures, and altered consciousness, and lumbar puncture revealed turbid cerebrospinal fluid (CSF) with elevated white blood cell count. Subsequent CSF culture confirmed Pseudomonas aeruginosa infection. Prompt initiation of appropriate antibiotic therapy, including a push dose of meropenem, resulted in clinical improvement. However, the patient exhibited post-meningitis sequelae, including hearing and visual impairments. Comprehensive follow-up care and rehabilitation services are crucial for managing these long-term complications. By sharing this case, we aim to increase awareness and facilitate early recognition of Pseudomonas aeruginosa meningitis, leading to improved patient care and outcomes in similar clinical scenarios.
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Affiliation(s)
| | - Lidia S Tefera
- Department of Pediatrics, Partners in Health, Harper, LBR
| | - Matthew Douglas-Vail
- Department of Emergency Medicine, University of British Columbia, Vancouver, CAN
| | - Arnold Ayebare
- Department of Microbiology, Partners in Health, Harper, LBR
| | | | - Bill P Davis
- Department of Pediatrics, James Jenkins (JJ) Dossen Hospital, Ministry of Health, Harper, LBR
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Mizusawa M, Carroll KC. Recent updates in the development of molecular assays for the rapid identification and susceptibility testing of MRSA. Expert Rev Mol Diagn 2023; 23:679-699. [PMID: 37419696 DOI: 10.1080/14737159.2023.2234823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/22/2023] [Accepted: 07/06/2023] [Indexed: 07/09/2023]
Abstract
INTRODUCTION Methicillin-resistant Staphylococcus aureus (MRSA) is a frequent cause of healthcare- and community-associated infections. Nasal carriage of MRSA is a risk factor for subsequent MRSA infections. Increased morbidity and mortality are associated with MRSA infections and screening and diagnostic tests for MRSA play an important role in clinical management. AREAS COVERED A literature search was conducted in PubMed and supplemented by citation searching. In this article, we provide a comprehensive review of molecular-based methods for MRSA screening and diagnostic tests including individual nucleic acid detection assays, syndromic panels, and sequencing technologies with a focus on their analytical performance. EXPERT OPINION Molecular based-assays for the detection of MRSA have improved in terms of accuracy and availability. Rapid turnaround enables earlier contact isolation and decolonization for MRSA. The availability of syndromic panel tests that include MRSA as a target has expanded from positive blood cultures to pneumonia and osteoarticular infections. Sequencing technologies allow detailed characterizations of novel methicillin-resistance mechanisms that can be incorporated into future assays. Next generation sequencing is capable of diagnosing MRSA infections that cannot be identified by conventional methods and metagenomic next-generation sequencing (mNGS) assays will likely move closer to implementation as front-line diagnostics in the near future.
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Affiliation(s)
- Masako Mizusawa
- Monmouth Medical Center, Rutgers University Robert Wood Johnson Medical School, Long Branch, NJ, USA
| | - Karen C Carroll
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Zhao L, Li P, Xu Z, Ji X, Guan L, Wang X, Luo J, Cheng H, Ye L. Diagnosis of post-neurosurgical bacterial meningitis in patients with aneurysmal subarachnoid hemorrhage based on the immunity-related proteomics signature of the cerebrospinal fluid. Front Neurol 2023; 14:1166598. [PMID: 37409018 PMCID: PMC10319054 DOI: 10.3389/fneur.2023.1166598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/30/2023] [Indexed: 07/07/2023] Open
Abstract
Introduction Post-neurosurgical bacterial meningitis (PNBM) is a serious complication for patients who receive neurosurgical treatment, but the diagnosis is difficult given the complicated microenvironment orchestrated by sterile brain injury and pathogenic infection. In this study, we explored potential diagnostic biomarkers and immunological features using a proteomics platform. Methods A total of 31 patients with aneurysmal subarachnoid hemorrhage (aSAH) who received neurosurgical treatment were recruited for this study. Among them, 15 were diagnosed with PNBM. The remaining 16 patients were categorized into the non-PNBM group. Proteomics analysis of the cerebrospinal fluid (CSF) was conducted on the Olink platform, which contained 92 immunity-related molecules. Results We found that the expressions of 27 CSF proteins were significantly different between the PNBM and non-PNBM groups. Of those 27 proteins, 15 proteins were upregulated and 12 were downregulated in the CSF of the PNBM group. The receiver operating characteristic curve analysis indicated that three proteins (pleiotrophin, CD27, and angiopoietin 1) had high diagnostic accuracy for PNBM. Furthermore, we also performed bioinformatics analysis to explore potential pathways and the subcellular localization of the proteins. Conclusion In summary, we found a cohort of immunity-related molecules that can serve as potential diagnostic biomarkers for PNBM in patients with aSAH. These molecules also provide an immunological profile of PNBM.
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12
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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: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Li X, Guo X, Liu Y, Chen R, Ma C, Kang X, Fang Yang, Li W, Jiang W. A case of treatment of multidrug-resistant intracranial Klebsiella pneumoniae infection by multichannel colistin sulfate. Future Microbiol 2023; 18:547-552. [PMID: 37314362 DOI: 10.2217/fmb-2022-0277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
The management of severe neurologic infections due to multidrug-resistant (MDR) Klebsiella pneumoniae infection remains a challenge. Limited antibiotic treatment regimens make treatment of severe MDR K. pneumoniae infection more difficult. We describe a patient who developed severe meningitis and ventriculitis after craniotomy caused by MDR K. pneumoniae and was effectively treated with the administration of multichannel applications (intravenous, intrathecal and aerosol inhalation) of colistin sulfate. This case provides clinical evidence that the intrathecal, intravenous and aerosol inhalation of colistin sulfate by multichannel application can be a last resort in refractory intracranial infection by MDR K. pneumoniae.
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Affiliation(s)
- Xiaona Li
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710000, China
| | - Xin Guo
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710000, China
| | - Yangfeng Liu
- Department of Neurology, Xijing 986 Hospital, Fourth Military Medical University, Xi'an, 710000, China
| | - Rong Chen
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710000, China
| | - Chen Ma
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710000, China
| | - Xiaogang Kang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710000, China
| | - Fang Yang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710000, China
| | - Wen Li
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710000, China
| | - Wen Jiang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710000, China
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Ye L, Ji X, Song Z, Guan L, Zhao L, Wang W, Du W. Clinical Value of Glycan Changes in Cerebrospinal Fluid for Evaluation of Post-Neurosurgical Bacterial Meningitis with Hemorrhagic Stroke Patients. Diagnostics (Basel) 2023; 13:diagnostics13020187. [PMID: 36672998 PMCID: PMC9858593 DOI: 10.3390/diagnostics13020187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/26/2022] [Accepted: 12/29/2022] [Indexed: 01/06/2023] Open
Abstract
Post-neurosurgical bacterial meningitis (PNBM) is one of the severe complications in patients receiving neurosurgical procedures. Recent studies have found microbe-related glycans play important roles in adhesion, invasion, and toxicity toward innate immunological reactions. In this study, we aimed to investigate the glycomic profile and its potential diagnostic efficacy in post-neurosurgical bacterial meningitis (PNBM) patients with hemorrhagic stroke. A total of 136 cerebrospinal fluid (CSF) samples were recruited and divided into a PNBM group and a non-PNBM group based on the clinical diagnostic criteria. A lectin biochip-based method was established for the detection of glycans in CSF. The clinicopathological data and biochemical parameters in CSF from all patients were analyzed. Two models for multivariate analysis investigating glycan changes in the CSF were conducted, aiming at determining the specific expression and diagnostic efficacy of lectin-probing glycans (LPGs) for PNBM. In univariate analysis, we found that 8 out of 11 LPGs were significantly correlated with PNBM. Model 1 multivariate analysis revealed that PNA (p = 0.034), Jacalin (p = 0.034) and LTL (p = 0.001) were differentially expressed in the CSF of PNBM patients compared with those of non-PNBM patients. Model 2 multivariate analysis further disclosed that LTL (p = 0.021) and CSF glucose (p < 0.001) had independent diagnostic efficacies in PNBM, with areas under the curve (AUC) of 0.703 and 0.922, respectively. In summary, this study provided a new insight into the subject of CSF glycomics concerning bacterial infection in patients with hemorrhagic stroke.
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Affiliation(s)
- Lei Ye
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
- Correspondence: (L.Y.); (W.D.); Tel.: +86-551-6292-2114 (L.Y.); +86-551-6516-1011 (W.D.); Fax: +86-551-6363-3742 (L.Y.); +86-551-6516-5628 (W.D.)
| | - Xuefei Ji
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
| | - Zijian Song
- Department of Orthopaedics, Xuzhou Municipal First People’s Hospital, Daxue Road 269, Xuzhou 221116, China
| | - Liao Guan
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
| | - Liang Zhao
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
| | - Wenwen Wang
- Department of Pathology, Anhui Medical University, Meishan Road 81, Hefei 230032, China
- School of Clinical Medicine, Anhui Medical University, Meishan Road 81, Hefei 230032, China
| | - Weidong Du
- Department of Pathology, Anhui Medical University, Meishan Road 81, Hefei 230032, China
- Correspondence: (L.Y.); (W.D.); Tel.: +86-551-6292-2114 (L.Y.); +86-551-6516-1011 (W.D.); Fax: +86-551-6363-3742 (L.Y.); +86-551-6516-5628 (W.D.)
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Tunckale T, Kavak C, Safak B, Gonen A, Erdem I. A case report of brain abscess caused by carbapenem-resistant Klebsiella pneumoniae. Rev Inst Med Trop Sao Paulo 2023; 65:e23. [PMID: 36995876 PMCID: PMC10041964 DOI: 10.1590/s1678-9946202365023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/10/2023] [Indexed: 03/30/2023] Open
Abstract
The treatment of infections caused by carbapenem-resistant Klebsiella pneumoniae (CR-Kp) strains is difficult due to the limited antimicrobial options and high mortality. There are many reports on intracranial infections caused by CR-Kp, but only a few on brain abscesses caused by CR-Kp. Here, we present a case of brain abscess caused by CR-Kp successfully treated with combined antibiotics. A 26-year-old male patient was admitted to our hospital due to high fever and headache. His past medical history includes a surgical intervention due to an acute subdural hematoma, performed at an external healthcare center. After the current diagnosis of cerebral abscess, he underwent two surgeries. During the procedure, multiple cerebral abscesses were drained and capsulotomies were performed under ultrasound guidance. The combination of meropenem and vancomycin was started. The contents of the abscesses were sent to the microbiology and pathology laboratory. On the 3 rd day of treatment, the medical team was informed that CR-Kp grew in an abscess culture. The patient’s treatment was changed to meropenem + colistin + tigecycline. The patient developed electrolyte disturbances during the follow-up and this was considered an adverse effect of colistin. On the 41 st day of treatment, colistin was discontinued, fosfomycin was added, and meropenem and tigecycline were maintained. Treatment was discontinued on the 68 th day, when the patient was discharged. The general condition of the patient, who has been followed up for two years, is satisfactory. The treatment of CR-Kp infections should be individualized, and the pharmacokinetics and pharmacodynamics of antibiotics should be considered in each case.
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Affiliation(s)
- Tamer Tunckale
- Namik Kemal University , Faculty of Medicine , Department of Neurosurgery , Tekirdag , Turkey
| | - Caglar Kavak
- Namik Kemal University , Faculty of Medicine , Department of Infectious Diseases , Tekirdag , Turkey
| | - Birol Safak
- Namik Kemal University , Faculty of Medicine , Department of Medical Microbiology , Tekirdag , Turkey
| | - Aysun Gonen
- Namik Kemal University , Faculty of Medicine , Department of Radiology , Tekirdag , Turkey
| | - Ilknur Erdem
- Namik Kemal University , Faculty of Medicine , Department of Infectious Diseases , Tekirdag , Turkey
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Haddad N, Carr M, Balian S, Lannin J, Kim Y, Toth C, Jarvis J. The Blood-Brain Barrier and Pharmacokinetic/Pharmacodynamic Optimization of Antibiotics for the Treatment of Central Nervous System Infections in Adults. Antibiotics (Basel) 2022; 11:antibiotics11121843. [PMID: 36551500 PMCID: PMC9774927 DOI: 10.3390/antibiotics11121843] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/08/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Bacterial central nervous system (CNS) infections are serious and carry significant morbidity and mortality. They encompass many syndromes, the most common being meningitis, which may occur spontaneously or as a consequence of neurosurgical procedures. Many classes of antimicrobials are in clinical use for therapy of CNS infections, some with established roles and indications, others with experimental reporting based on case studies or small series. This review delves into the specifics of the commonly utilized antibacterial agents, updating their therapeutic use in CNS infections from the pharmacokinetic and pharmacodynamic perspectives, with a focus on the optimization of dosing and route of administration that have been described to achieve good clinical outcomes. We also provide a concise synopsis regarding the most focused, clinically relevant information as pertains to each class and subclass of antimicrobial therapeutics. CNS infection morbidity and mortality remain high, and aggressive management is critical in ensuring favorable patient outcomes while averting toxicity and upholding patient safety.
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Affiliation(s)
- Nicholas Haddad
- College of Medicine, Central Michigan University (CMU), Mt Pleasant, MI 48859, USA
- Correspondence: ; Tel.: +1-(989)-746-7860
| | | | - Steve Balian
- CMU Medical Education Partners, Saginaw, MI 48602, USA
| | | | - Yuri Kim
- CMU Medical Education Partners, Saginaw, MI 48602, USA
| | - Courtney Toth
- Ascension St. Mary’s Hospital, Saginaw, MI 48601, USA
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Prabhakar H. The Menace of Meningitis! Indian J Crit Care Med 2022; 26:1231-1232. [PMID: 36755626 PMCID: PMC9886016 DOI: 10.5005/jp-journals-10071-24368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 11/18/2022] [Indexed: 12/05/2022] Open
Abstract
How to cite this article: Prabhakar H. The Menace of Meningitis! Indian J Crit Care Med 2022;26(12):1231-1232.
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Affiliation(s)
- Hemanshu Prabhakar
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India,Hemanshu Prabhakar, Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India, Phone: +91-011-26593474, e-mail:
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18
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Xie R, Song X, Chen H, Lin P, Guo S, Zhuang Z, Chen Y, Zhao W, Zhao P, Long H, Tao J. Intelligent Clinical Lab for the Diagnosis of Post-Neurosurgical Meningitis Based on Machine-Learning-Aided Cerebrospinal Fluid Analysis. Anal Chem 2022; 94:15720-15728. [DOI: 10.1021/acs.analchem.2c03154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ruirui Xie
- School of Chemistry and Chemical Engineering, South China University of Technology, Guangzhou 510640, P. R. China
- NMPA Key Laboratory for Research and Evaluation of Drug Metabolism, Guangdong Provincial Key Laboratory of New Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
| | - Xiangfei Song
- NMPA Key Laboratory for Research and Evaluation of Drug Metabolism, Guangdong Provincial Key Laboratory of New Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
| | - Huiting Chen
- School of Chemistry and Chemical Engineering, South China University of Technology, Guangzhou 510640, P. R. China
| | - Peiru Lin
- NMPA Key Laboratory for Research and Evaluation of Drug Metabolism, Guangdong Provincial Key Laboratory of New Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
| | - Siyun Guo
- NMPA Key Laboratory for Research and Evaluation of Drug Metabolism, Guangdong Provincial Key Laboratory of New Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
| | - Zehong Zhuang
- NMPA Key Laboratory for Research and Evaluation of Drug Metabolism, Guangdong Provincial Key Laboratory of New Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
| | - Yuying Chen
- School of Chemistry and Chemical Engineering, South China University of Technology, Guangzhou 510640, P. R. China
| | - Wei Zhao
- Division of Vascular and Interventional Radiology, Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong, China
| | - Peng Zhao
- NMPA Key Laboratory for Research and Evaluation of Drug Metabolism, Guangdong Provincial Key Laboratory of New Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
- Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Southern Medical University, Guangzhou 510515, China
| | - Hao Long
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Jia Tao
- School of Chemistry and Chemical Engineering, South China University of Technology, Guangzhou 510640, P. R. China
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Arkell P, Wilson R, Watkins K, Antcliffe DB, Gilchrist M, Wilson M, Rawson TM, Holmes A. Application of therapeutic drug monitoring to the treatment of bacterial central nervous system infection: a scoping review. J Antimicrob Chemother 2022; 77:3408-3413. [PMID: 36227686 DOI: 10.1093/jac/dkac332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Bacterial central nervous system (CNS) infection is challenging to treat and carries high risk of recurrence, morbidity, and mortality. Low CNS penetration of antibiotics may contribute to poor clinical outcomes from bacterial CNS infections. The current application of therapeutic drug monitoring (TDM) to management of bacterial CNS infection was reviewed. METHODS Studies were included if they described adults treated for a suspected/confirmed bacterial CNS infection and had antibiotic drug concentration(s) determined that affected individual treatment. RESULTS One-hundred-and-thirty-six citations were retrieved. Seventeen manuscripts were included describing management of 68 patients. TDM for vancomycin (58/68) and the beta-lactams (29/68) was most common. Timing of clinical sampling varied widely between studies and across different antibiotics. Methods for setting individual PK-PD targets, determining parameters and making treatment changes varied widely and were sometimes unclear. DISCUSSION Despite increasing observational data showing low CNS penetration of various antibiotics, there are few clinical studies describing practical implementation of TDM in management of CNS infection. Lack of consensus around clinically relevant CSF PK-PD targets and protocols for dose-adjustment may contribute. Standardised investigation of TDM as a tool to improve treatment is required, especially as innovative drug concentration-sensing and PK-PD modelling technologies are emerging. Data generated at different centres offering TDM should be open access and aggregated to enrich understanding and optimize application.
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Affiliation(s)
- Paul Arkell
- Department of Infectious Disease, Centre for Antimicrobial Optimisation, Imperial College London, Hammersmith Hospital, Du Cane Road, UK
| | - Richard Wilson
- Department of Infectious Disease, Centre for Antimicrobial Optimisation, Imperial College London, Hammersmith Hospital, Du Cane Road, UK.,Department of Infectious Disease, National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, UK.,Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L69 3BX, UK.,Department of Pharmacy, Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Killian Watkins
- Department of Infectious Disease, Centre for Antimicrobial Optimisation, Imperial College London, Hammersmith Hospital, Du Cane Road, UK
| | - David B Antcliffe
- Department of Infectious Disease, Centre for Antimicrobial Optimisation, Imperial College London, Hammersmith Hospital, Du Cane Road, UK.,Department of Anaesthesia and Critical Care, Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London W2 1NY, UK.,Division of Anaesthesia, Pain and Critical Care Medicine, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
| | - Mark Gilchrist
- Department of Infectious Disease, Centre for Antimicrobial Optimisation, Imperial College London, Hammersmith Hospital, Du Cane Road, UK.,Department of Infectious Disease, National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, UK.,Department of Pharmacy, Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Mark Wilson
- Department of Neurosurgery, Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Timothy M Rawson
- Department of Infectious Disease, Centre for Antimicrobial Optimisation, Imperial College London, Hammersmith Hospital, Du Cane Road, UK.,Department of Infectious Disease, National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, UK
| | - Alison Holmes
- Department of Infectious Disease, Centre for Antimicrobial Optimisation, Imperial College London, Hammersmith Hospital, Du Cane Road, UK.,Department of Infectious Disease, National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, UK.,Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L69 3BX, UK
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Hönikl LS, Lange N, Barz M, Negwer C, Meyer B, Gempt J, Meyer HS. Postoperative communicating hydrocephalus following glioblastoma resection: Incidence, timing and risk factors. Front Oncol 2022; 12:953784. [PMID: 36172160 PMCID: PMC9510976 DOI: 10.3389/fonc.2022.953784] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionGlioblastoma (GBM) is the most common malignant primary brain tumor. Treatment includes maximally safe surgical resection followed by radiation and/or chemotherapy. However, resection can lead to ventricular opening, potentially increasing the risk for development of communicating hydrocephalus (CH). Complications such as rebleeding and infection may also lead to CH and, eventually, the need for cerebrospinal fluid (CSF) diversion surgery. In this study, we evaluated the incidence of different types of hydrocephalus and potential risk factors for the development of CH following glioblastoma resection.Methods726 GBM patients who underwent tumor resection at our department between 2006 and 2019 were analyzed retrospectively. Potential risk factors that were determined for each patient were age, sex, tumor location, the number of resection surgeries, ventricular opening during resection, postoperative CSF leak, ventriculitis, and rebleeding. Uni- as well as multivariate analyses were performed to identify associations with CH and independent risk factors.Results55 patients (7.6%) needed CSF diversion surgery (implantation of a ventriculoperitoneal or ventriculoatrial shunt) following resection surgery. 47 patients (6.5%) had CH, on median, 24 days after the last resection (interquartile range: 17-52 days). 3 patients had obstructive hydrocephalus (OH) and 5 patients had other CSF circulation disorders. Ventricular opening (odds ratio (OR): 7.9; p=0.000807), ventriculitis (OR 3.3; p=0.000754), and CSF leak (OR 2.3; p=0.028938) were identified as significant independent risk factors for the development of post-resection CH. Having more than one resection surgery was associated with CH as well (OR 2.1; p=0.0128), and frontal tumors were more likely to develop CH (OR 2.4; p=0.00275), while temporal tumors were less likely (OR 0.41; p=0.0158); However, none of those were independent risk factors. Age, sex, or rebleeding were not associated with postoperative CH.ConclusionPostoperative CH requiring CSF shunting is not infrequent following GBM resection and is influenced by surgery-related factors. It typically occurs several weeks after resection. If multiple risk factors are present, one should discuss the possibility of postoperative CH with the patient and maybe even consider pre-emptive shunt implantation to avoid interruption of adjuvant tumor therapy. The incidence of CH requiring shunting in GBM patients could rise in the future.
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Wu Y, Zhang Y, Wu Y, Zhu G, Xue Y, Qu Y, Zhao T. Postoperative Early Lumbar Drainage Can Reduce the Duration of Fever or Infection in Patients with Complicated Intracranial Tumors after a Long Operation Time. Neurol India 2022; 70:1435-1442. [PMID: 36076640 DOI: 10.4103/0028-3886.355097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Intracranial fever or infection is one of the common complications after craniotomy, especially for complicated intracranial tumors such as deep skull base tumors. Objective We used early cerebrospinal fluid (CSF) drainage with a preplaced lumbar drainage (LD) tube after surgery and observed whether this procedure could reduce the rate and duration of fever or infection. Material and Methods The authors conducted a retrospective study of 142 patients who underwent complicated intracranial tumor surgery with no less than four hours of dural opening at the Center of Neurosurgery of Tangdu Hospital. The LD group underwent preoperative LD placement, intraoperative CSF release and postoperative continuous drainage, but the control group received routine craniotomy without preoperative LD. The primary outcomes included the rate, duration, and hospital length of stay (LOS) for patients with fever or infection after surgery, as compared between the two groups. The second outcome included complications related to LD and the rate of postoperative CSF leakage. Results There were 22 patients in the LD group and 23 patients in the control group who presented with delayed fever, which was supposed to be caused by intracranial infection or aseptic inflammation. The median duration of delayed fever in the LD group was obviously lower than that in the control group (7.762 ± 3.129 days vs 11.73 ± 5.239 days), and there was a statistically significant difference (P = 0.0046). In addition, there was a significant reduction in the median postoperative LOS (12 [8,10,15,21] days in the LD group vs 15 [9,13,20,28] days in the controls). Moreover, there was no significant difference in complications related to LD between the two groups. Three patients with brain herniation were observed in the LD group compared with one patient in the control group. All four patients had contemporary mild-to-moderate neurologic disorders after surgery or conservative treatment. Additionally, the rate of CSF leakage in the LD group was 5.41% (4/74), which was lower than that in the control group (8/68, [11.76%]), although there was no significant difference (P = 0.174). Conclusions For patients receiving complicated intracranial lesions following a long operation time, postoperative early LD was beneficial for the treatment of patients with fever or infection. It not only reduced the duration of infection or fever in postoperative patients but also decreased the postoperative LOS. We should minimize the complications related to LD by careful and standardized LD and management processes, and ensure the effectiveness and safety of this treatment.
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Affiliation(s)
- Yingxi Wu
- Department of Neurosurgery, Tangdu Hospital, The Air Force Medical University, Xi'an, China
| | - Yunze Zhang
- Department of Neurosurgery, Tangdu Hospital, The Air Force Medical University, Xi'an, China
| | - Yang Wu
- Department of Neurosurgery, Tangdu Hospital, The Air Force Medical University, Xi'an, China
| | - Gang Zhu
- Department of Neurosurgery, Tangdu Hospital, The Air Force Medical University, Xi'an, China
| | - Yafei Xue
- Department of Neurosurgery, Tangdu Hospital, The Air Force Medical University, Xi'an, China
| | - Yan Qu
- Department of Neurosurgery, Tangdu Hospital, The Air Force Medical University, Xi'an, China
| | - Tianzhi Zhao
- Department of Neurosurgery, Tangdu Hospital, The Air Force Medical University, Xi'an, China
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Plastun VO, Prikhozhdenko ES, Gusliakova OI, Raikova SV, Douglas TEL, Sindeeva OA, Mayorova OA. WPI Hydrogels with a Prolonged Drug-Release Profile for Antimicrobial Therapy. Pharmaceutics 2022; 14:1199. [PMID: 35745772 PMCID: PMC9231275 DOI: 10.3390/pharmaceutics14061199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/28/2022] [Accepted: 06/02/2022] [Indexed: 12/10/2022] Open
Abstract
Infectious sequelae caused by surgery are a significant problem in modern medicine due to their reduction of therapeutic effectiveness and the patients’ quality of life.Recently, new methods of local antimicrobial prophylaxis of postoperative sequelae have been actively developed. They allow high local concentrations of drugs to be achieved, increasing the antibiotic therapy’s effectiveness while reducing its side effects. We have developed and characterized antimicrobial hydrogels based on an inexpensive and biocompatible natural substance from the dairy industry—whey protein isolate—as matrices for drug delivery. The release of cefazolin from the pores of hydrogel structures directly depends on the amount of the loaded drug and occurs in a prolonged manner for three days. Simultaneously with the antibiotic release, hydrogel swelling and partial degradation occurs. The WPI hydrogels absorb solvent, doubling in size in three days and retaining cefazolin throughout the duration of the experiment. The antimicrobial activity of cefazolin-loaded WPI hydrogels against Staphylococcus aureus growth is prolonged in comparison to that of the free cefazolin. The overall cytotoxic effect of cefazolin-containing WPI hydrogels is lower than that of free antibiotics. Thus, our work shows that antimicrobial WPI hydrogels are suitable candidates for local antibiotic therapy of infectious surgical sequelae.
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23
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Panic H, Gjurasin B, Santini M, Kutlesa M, Papic N. Etiology and Outcomes of Healthcare-Associated Meningitis and Ventriculitis—A Single Center Cohort Study. Infect Dis Rep 2022; 14:420-7. [PMID: 35735755 PMCID: PMC9222399 DOI: 10.3390/idr14030045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 02/04/2023] Open
Abstract
Healthcare associated meningitis and ventriculitis (HCAMV) are serious complications of neurosurgical procedures. We conducted a retrospective cohort study of patients with HCAMV treated at the University Hospital for Infectious Diseases Zagreb during the 2013–2019 period. A total of 144 patients with 151 episodes of HCAMV were included. The most common indications for neurosurgical procedures were brain tumor, hemorrhage and hydrocephalus. Etiology was identified in 90 (59.6%) episodes (either positive CSF culture or positive PCR), and in other 61 (40.39%) the diagnosis of HCAMV was made based on clinical and CSF parameters, without microbiologic confirmation. Carbapenem-resistant Acinetobacter baumannii was the most common pathogen (15.89%), followed by Staphylococcus aureus (13.91%), Pseudomonas aeruginosa (13.25%) and Coagulase negative staphylococci (7.95%). Overall, 24 (16.3%) patients died, and the majority had adverse outcomes, persistent vegetative state (8, 5.56%) and severe disability (31, 21.53%). The worst clinical outcomes were observed in A. baumannii infections. High rate of complications, the need for external ventricular drainage (re)placement often complicated with nosocomial infections and prolonged stay in intensive care units were observed. Clinicians should be aware of local microbial epidemiology on guiding proper empirical antimicrobial treatment in patients with HCAMV.
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24
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Abstract
A woman in her 50s developed meningitis following an endoscopic, endonasal resection of a clival meningioma which was complicated by a cerebrospinal fluid (CSF) leak through the nose. CSF analysis showed a raised white cell count, and Capnocytophaga sputigena was isolated. This organism is an oral commensal and is implicated in periodontal disease; the CSF leak explains the portal of entry. C. sputigena is rarely isolated, and this is the first report of a central nervous system (CNS) infection caused by this organism. A worsening of our patient's dermatological condition, urticaria pigmentosa, coincided with empiric treatment with vancomycin and meropenem, which were therefore discontinued. Treatment was continued with chloramphenicol for 3 weeks, and the patient made a full recovery. Systemic chloramphenicol is uncommonly used in contemporary UK practice, but remains an excellent antibiotic for CNS penetration and it has excellent bioavailability. We anticipate increased chloramphenicol use as the number of multiresistant Gram-negative infection increases.
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Affiliation(s)
- Terry John Evans
- Infection Care Group, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Samitha Fernando
- Infection Care Group, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Micaela Uberti
- Department of Neurosurgery, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Andrew J Martin
- Department of Neurosurgery, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Marina Basarab
- Infection Care Group, St George's University Hospitals NHS Foundation Trust, London, UK
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25
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Pautova AK, Meglei AY, Chernevskaya EA, Alexandrova IA, Beloborodova NV. 4-Hydroxyphenyllactic Acid in Cerebrospinal Fluid as a Possible Marker of Post-Neurosurgical Meningitis: Retrospective Study. J Pers Med 2022; 12:399. [PMID: 35330399 PMCID: PMC8955909 DOI: 10.3390/jpm12030399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 11/17/2022] Open
Abstract
The search for new potential biomarkers for the diagnostics of post-neurosurgical bacterial meningitis is required because of the difficulties in its early verification using results of the routine laboratory and biochemical analyses of the cerebrospinal fluid (CSF). The goal of the study was to determine the contents of the aromatic metabolites and biomarkers in the CSF samples of the post-neurosurgical patients (n = 82) and their potential diagnostical significance for the evaluation of the risk of post-neurosurgical meningitis. Patients with signs of post-neurosurgical meningitis (n = 30) had lower median values of glucose and higher values of cell count, neutrophils, lactate, protein, 3-(4-hydroxyphenyl)lactic acid (p-HPhLA), and interleukin-6 (IL-6) than patients without signs of post-neurosurgical meningitis (n = 52). ROC analysis for IL-6 and p-HPhLA resulted in 0.785 and 0.734 values of the area under the ROC curve, with sensitivity 96.30 and 66.67%; specificity 54.17 and 82.69%, respectively. IL-6 should be considered as a non-specific biomarker, in contrast to the microbial metabolite p-HPhLA. If the concentration of p-HPhLA was more or equal to 0.9 µmol/L, the risk of bacterial complications was 9.6 times higher. p-HPhLA is a promising marker for the prognosis of post-neurosurgical meningitis, and its determination on a larger group of post-neurosurgical patients can subsequently prove its diagnostic significance for the verification of CNS infections.
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26
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Brink AJ, Centner CM, Opperman S. Microbiology Assessments in Critically Ill Patients. Semin Respir Crit Care Med 2022; 43:75-96. [PMID: 35172360 DOI: 10.1055/s-0041-1741018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The prevalence of suspected or proven infections in critically ill patients is high, with a substantial attributable risk to in-hospital mortality. Coordinated guidance and interventions to improve the appropriate microbiological assessment for diagnostic and therapeutic decisions are therefore pivotal. Conventional microbiology follows the paradigm of "best practice" of specimen selection and collection, governed by laboratory processing and standard operating procedures, and informed by the latest developments and trends. In this regard, the preanalytical phase of a microbiological diagnosis is crucial since inadequate sampling may result in the incorrect diagnosis and inappropriate management. In addition, the isolation and detection of contaminants interfere with multiple intensive care unit (ICU) processes, which confound the therapeutic approach to critically ill patients. To facilitate bedside enablement, the microbiology laboratory should provide expedited feedback, reporting, and interpretation of results. Compared with conventional microbiology, novel rapid and panel-based diagnostic strategies have the clear advantages of a rapid turnaround time, the detection of many microorganisms including antimicrobial resistant determinants and thus promise substantial improvements in health care. However, robust data on the clinical evaluation of rapid diagnostic tests in presumed sepsis, sepsis and shock are extremely limited and more rigorous intervention studies, focusing on direct benefits for critically ill patients, are pivotal before widespread adoption of their use through the continuum of ICU stay. Advocating the use of these diagnostics without firmly establishing which patients would benefit most, how to interpret the results, and how to treat according to the results obtained, could in fact be counterproductive with regards to diagnostic "best practice" and antimicrobial stewardship. Thus, for the present, they may supplement but not yet supplant conventional microbiological assessments.
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Affiliation(s)
- Adrian John Brink
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
| | - Chad M Centner
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
| | - Stefan Opperman
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,National Health Laboratory Service, Green Point, Cape Town, South Africa
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27
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Jang Y, Kim S, Kim N, Son H, Ha EJ, Koh EJ, Phi JH, Park C, Kim JE, Kim S, Lee SK, Cho W, Moon J, Chu K. Nanopore
16S
sequencing enhances the detection of bacterial meningitis after neurosurgery. Ann Clin Transl Neurol 2022; 9:312-325. [PMID: 35124895 PMCID: PMC8935320 DOI: 10.1002/acn3.51517] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/10/2022] [Accepted: 01/25/2022] [Indexed: 12/19/2022] Open
Abstract
Objective Nosocomial bacterial meningitis is one of the major complications after neurosurgery. We performed nanopore 16S amplicon sequencing from cerebrospinal fluid (CSF) to evaluate bacterial meningitis in patients who underwent neurosurgery. Methods Among the patients who visited the neurosurgery department of Seoul National University Hospital between July 2017 and June 2020, those with clinically suspected bacterial meningitis were included. 16S rDNA PCR was performed from the CSF, and nanopore sequencing was performed for up to 3 h. The reads were aligned to the BLAST database. In each case, the culture and the 16S rRNA gene amplicon analysis were simultaneously performed and compared with each other, and we retrospectively reviewed the medical records. Genuine infection was determined by the identical results between conventional culture study and the sequencing, or clinically determined in cases with inconsistent results between the two methods. Results Of the 285 samples obtained from 178 patients who had 16S rDNA PCR, 41 samples (14.4%) were diagnosed with genuine infection. A total of 56.1% (23/41) of the samples with genuine infection showed a false‐negative culture test. In particular, 16S amplicon sequencing was useful in evaluating patients at the initial tests who had infection with intraventricular hemorrhage (Culture false‐negative rate = 100%), subarachnoid hemorrhage (Culture false‐negative rate = 77.8%), and systemic cancer (Culture false‐negative rate = 100%), which are risk factors for central fever. Moreover, 16S amplicon sequencing could suggest the possibility of persistent bacterial meningitis in empirical antibiotic use. Conclusion CSF nanopore 16S sequencing was more effective than conventional CSF culture studies in postoperative bacterial meningitis and may contribute to evidence‐based decisions for antibiotic maintenance and discontinuation.
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Affiliation(s)
- Yoonhyuk Jang
- Department of Neurology Seoul National University College of Medicine Seoul National University Hospital Seoul South Korea
| | - Seondeuk Kim
- Department of Neurology Seoul National University College of Medicine Seoul National University Hospital Seoul South Korea
| | - Narae Kim
- Department of Neurology Seoul National University College of Medicine Seoul National University Hospital Seoul South Korea
| | - Hyoshin Son
- Department of Neurosurgery Seoul National University College of Medicine, Seoul National University Hospital Seoul South Korea
| | - Eun Jin Ha
- Department of Neurosurgery Seoul National University College of Medicine, Seoul National University Hospital Seoul South Korea
| | - Eun Jung Koh
- Department of Neurosurgery Seoul National University College of Medicine, Seoul National University Hospital Seoul South Korea
- Division of Pediatric Neurosurgery Seoul National University Children's Hospital Seoul South Korea
| | - Ji Hoon Phi
- Department of Neurosurgery Seoul National University College of Medicine, Seoul National University Hospital Seoul South Korea
- Division of Pediatric Neurosurgery Seoul National University Children's Hospital Seoul South Korea
| | - Chul‐Kee Park
- Department of Neurosurgery Seoul National University College of Medicine, Seoul National University Hospital Seoul South Korea
| | - Jeong Eun Kim
- Department of Neurosurgery Seoul National University College of Medicine, Seoul National University Hospital Seoul South Korea
| | - Seung‐Ki Kim
- Department of Neurosurgery Seoul National University College of Medicine, Seoul National University Hospital Seoul South Korea
- Division of Pediatric Neurosurgery Seoul National University Children's Hospital Seoul South Korea
| | - Sang Kun Lee
- Department of Neurology Seoul National University College of Medicine Seoul National University Hospital Seoul South Korea
| | - Won‐Sang Cho
- Department of Neurosurgery Seoul National University College of Medicine, Seoul National University Hospital Seoul South Korea
| | - Jangsup Moon
- Department of Neurology Seoul National University College of Medicine Seoul National University Hospital Seoul South Korea
- Department of Genomic Medicine Seoul National University Hospital Seoul South Korea
| | - Kon Chu
- Department of Neurology Seoul National University College of Medicine Seoul National University Hospital Seoul South Korea
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28
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Karvouniaris M, Brotis A, Tsiakos K, Palli E, Koulenti D. Current Perspectives on the Diagnosis and Management of Healthcare-Associated Ventriculitis and Meningitis. Infect Drug Resist 2022; 15:697-721. [PMID: 35250284 PMCID: PMC8896765 DOI: 10.2147/idr.s326456] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/05/2022] [Indexed: 12/31/2022] Open
Abstract
Ventriculitis or post-neurosurgical meningitis or healthcare-associated ventriculitis and meningitis (VM) is a severe infection that complicates central nervous system operations or is related to the use of neurosurgical devices or drainage catheters. It can further deteriorate patients who have already presented significant neurologic injury and is associated with high morbidity, mortality, and poor functional outcome. VM can be difficult to distinguish from aseptic meningitis, inflammation that follows hemorrhagic strokes and neurosurgical operations. The associated microorganisms can be either skin flora or nosocomial pathogens, most commonly, Gram-negative bacteria. Classical microbiology can fail to isolate the culprit pathogen. Novel cerebrospinal fluid (CSF) biomarkers and molecular microbiology can fill the diagnostic gap and expedite pathogen identification and treatment. The pathogens may demonstrate significant resistant patterns and their antibiotic treatment can be difficult, as many important drug classes, including the beta-lactams and the glycopeptides, hardly penetrate to the CSF, and do not achieve therapeutic levels at the site of the infection. Treatment modifications, such as higher daily dose and prolonged or continuous administration, might increase antibiotic levels in the site of infection and facilitate pathogens clearance. However, in the case of therapeutic failure or infection due to difficult-to-treat bacteria, the direct antibiotic instillation into the CSF, in addition to the intravenous antibiotic delivery, may help in the resolution of infection. However, intraventricular antibiotic therapy may result in aseptic meningitis and seizures, concerning the administration of aminoglycosides, polymyxins, and vancomycin. Meanwhile, bacteria form biofilms on the catheter or the device that should routinely be removed. Novel neurosurgical treatment modalities comprise endoscopic evacuation of debris and irrigation of the ventricles. VM prevention includes perioperative antibiotics, antimicrobial impregnated catheters, and the implementation of standardized protocols, regarding catheter insertion and manipulation.
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Affiliation(s)
- Marios Karvouniaris
- Intensive Care Unit, AHEPA University Hospital, Thessaloniki, Greece
- Correspondence: Marios Karvouniaris, ACHEPA University Hospital, S.Kiriakidi 1, Thessaloniki, 54636, Greece, Tel +302313303645, Fax +302313303096, Email
| | - Alexandros Brotis
- Neurosurgery Department, University Hospital of Larissa, Larissa, Greece
| | | | - Eleni Palli
- Intensive Care Unit, University Hospital of Larissa, Larissa, Greece
| | - Despoina Koulenti
- Second Critical Care Department, Attikon University Hospital, Athens, Greece
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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29
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Valdoleiros SR, Torrão C, Freitas LS, Mano D, Gonçalves C, Teixeira C. Nosocomial meningitis in intensive care: a 10-year retrospective study and literature review. Acute Crit Care 2022; 37:61-70. [PMID: 35081705 PMCID: PMC8918708 DOI: 10.4266/acc.2021.01151] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/08/2021] [Indexed: 12/03/2022] Open
Abstract
Background Nosocomial meningitis is a medical emergency that requires early diagnosis, prompt initiation of therapy, and frequent admission to the intensive care unit (ICU). Methods A retrospective study was conducted in adult patients diagnosed with nosocomial meningitis who required admission to the ICU between April 2010 and March 2020. Meningitis/ventriculitis and intracranial infection were defined according to Centers for Disease Control and Prevention guidelines. Results An incidence of 0.75% of nosocomial meningitis was observed among 70 patients. The mean patient age was 59 years and 34% were ≥65 years. Twenty-two percent of patients were in an immunocompromised state. A clear predisposing factor for nosocomial meningitis (traumatic brain injury, basal skull fracture, brain hemorrhage, central nervous system [CNS] invasive procedure or device) was present in 93% of patients. Fever was the most frequent clinical feature. A microbiological agent was identified in 30% of cases, of which 27% were bacteria, with a predominance of Gram-negative over Gram-positive. Complications developed in 47% of cases, 24% of patients were discharged with a Glasgow coma scale <14, and 37% died. There were no clear clinical predictors of complications. Advanced age (≥65 years old) and the presence of complications were associated with higher hospital mortality. Conclusions Nosocomial meningitis in critical care has a low incidence rate but high mortality and morbidity. In critical care patients with CNS-related risk factors, a high level of suspicion for meningitis is warranted, but diagnosis can be hindered by several confounding factors.
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Affiliation(s)
- Sofia R Valdoleiros
- Department of Infectious Diseases, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Cristina Torrão
- Department of Intensive Care, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Laura S Freitas
- Department of Emergency, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Diana Mano
- Department of Intensive Care, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Celina Gonçalves
- Department of Intensive Care, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Carla Teixeira
- Department of Intensive Care, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.,CriticalMed Cintesis, Centro de Investigação em Tecnologias e Serviços de Saúde, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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30
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Agarwal P, Gupta N, Srivastava A, Kumar M, Kumar S, Srivastava C. Anaplastic Intraventricular Meningioma with Rhabdoid Features: An Unusual Tumor with Usual Clinical Presentation. Clin Med�Insights�Pathol 2022; 15:2632010X221115157. [PMID: 35923857 PMCID: PMC9340328 DOI: 10.1177/2632010x221115157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/05/2022] [Indexed: 12/07/2022]
Abstract
Meningiomas are tumors arising from leptomeninges. Malignant counterpart of them is known
as anaplastic meningioma which are WHO grade III tumors. Intraventricular location of
these tumors is rare and is clinic-radiologically challenging. Histopathology and
immunohistochemistry are confirmatory. We present case of a 27-year-old girl, who
presented with usual symptoms of intraventricular mass in emergency. After shunt surgery,
clinical diagnosis of ependymoma was formed with differential of high-grade glioma. Squash
tissue was difficult to crush displaying tight clusters of spindle cells with necrosis in
background. Definitive histology revealed high grade spindle cell neoplasm disposed in
sheets with brisk and atypical mitosis. Only focal whorling pattern was seen. Large cells
with eccentric cytoplasm, reminiscent of rhabdoid cells were also seen.
Immunohistochemistry was positive for vimentin and EMA, negative for GFAP. Final diagnosis
of Anaplastic meningioma was dispatched. The histological pattern of the present case,
young age of presentation and presence of Rhabdoid cells make it unusual. Though rare but
intraventricular meningiomas must also be kept in clinical radiological differentials
apart from the usual ependymoma at this location.
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Affiliation(s)
- Preeti Agarwal
- Department of Pathology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Nancy Gupta
- Department of Pathology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Alok Srivastava
- Department of Neurosurgery, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Madhu Kumar
- Department of Pathology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Suarabh Kumar
- Department of Radiodiagnosis, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Chhitij Srivastava
- Department of Neurosurgery, King George’s Medical University, Lucknow, Uttar Pradesh, India
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31
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Sharipov OI, Ershova ON, Kurdyumova NV, Kalinin PL. [Nosocomial meningitis in endoscopic transsphenoidal surgery]. Zh Vopr Neirokhir Im N N Burdenko 2022; 86:89-95. [PMID: 35942842 DOI: 10.17116/neiro20228604189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
One of the main problems of transsphenoidal surgery is the risk of infectious complications. Nosocomial meningitis (NCM) can lead to increased length of hospital stay and financial costs, poor treatment outcomes and even mortality. This complication is an indicator of the quality of medical care for patients with neurosurgical diseases. The purpose of the review was to study the main risk factors of NCM, modern schemes for antibiotic prophylaxis and treatment of this complication after endoscopic transsphenoidal surgery. The main risk factors of meningitis are intra- and postoperative CSF leakage, overweight, diabetes mellitus, previous transsphenoidal surgeries and radiotherapy. To date, there are no generally accepted periods for antibiotic prophylaxis in nasal CSF leakage, installed external ventricular / lumbar drains or tampons in nasal cavity. Antibiotic prophylaxis should not exceed 3 postoperative days due to the risk of cultivating the drug-resistant organisms. If NCM is detected, treatment should be initiated immediately with a broad spectrum of antibiotics.
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Affiliation(s)
| | - O N Ershova
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - P L Kalinin
- Burdenko Neurosurgical Center, Moscow, Russia
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32
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Tuon FF, Yamada CH, Cieslinski J, Dos Santos Oliveira D, Ribeiro VST, Gasparetto J, Telles JP. Cerebrospinal Fluid Penetration of Vancomycin During Continuous Infusion Therapy in Patients With Nosocomial Ventriculitis. Ther Drug Monit 2021; 43:807-11. [PMID: 34780393 DOI: 10.1097/FTD.0000000000000907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/15/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study aimed to evaluate the utility of a commercial kit used to measure serum vancomycin concentrations to determine vancomycin concentrations in cerebrospinal fluid (CSF) samples and evaluate CSF penetration when administered as a continuous high-dose infusion in patients with nosocomial ventriculitis. METHODS This study included patients with external ventricular drain infection who were admitted to the intensive care unit between January 2018 and September 2020. After validation, CSF samples from 33 patients were collected. All patients received 30 mg/kg of vancomycin as a loading dose followed by 60 mg/kg as a maintenance dose in continuous infusion; all CSF samples were collected at least 48 hours after the first dose. RESULTS Thirty-three patients were enrolled in this study. The median serum creatinine level was 0.66 mg/dL (0.5-0.92; n = 30), and median creatinine clearance was 119.2 mL/min (64.6-138.4; n = 13). The median serum vancomycin 24-hour area under the curve (AUC24h) was 838 mg*h/L (515-1010). The median CSF vancomycin concentration was 5.20 mg/L (1.95-12.4). Median serum vancomycin concentration was 34.9 mg/L (21.47-42.1), and median CSF/serum ratio was 18.6% (8.4-41.5). Acute renal injury occurred in 21% (n = 7) of the patients by the end of the therapy. In addition, the vancomycin CSF/serum ratio was positively correlated with the median serum creatinine level (r = 0.670; P = 0.004). CONCLUSIONS Commercial vancomycin kits used to measure serum samples may be used to evaluate vancomycin concentrations in the CSF. Vancomycin penetration into CSF was 18.6%.
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Reardon T, Marsh C, Rippe P, Ruzys D, Ayres B, Cline D, Fiani B. Clinical management of pediatric chordomas: a comprehensive review. Acta Neurol Belg 2021; 121:1407-1414. [PMID: 34648142 DOI: 10.1007/s13760-021-01821-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 10/03/2021] [Indexed: 11/26/2022]
Abstract
Chordomas are malignant tumors derived from remnants of the notochord. These are extremely rare in pediatric patients, accounting for approximately 5% of all chordomas, with most lesions occupying the cranium. Chordomas also can occupy all levels of the spine, demonstrating a broad spectrum of neurologic presentation. Optimal treatment aims for gross total resection with accompanying radiation therapy to prevent recurrence. Their aggressive and infiltrative nature makes clinical management challenging, involving multiple disciplines and close monitoring to ensure optimal outcomes. This comprehensive review aims to cover the genetics, demographics, pathogenesis, neurologic sequelae, radiological considerations, chemotherapeutic management, surgical management, and post-operative considerations of pediatric chordoma patients.
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Affiliation(s)
- Taylor Reardon
- Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville, KY, USA.
| | - Caleb Marsh
- Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville, KY, USA
| | - Preston Rippe
- Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville, KY, USA
| | - Donatas Ruzys
- Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville, KY, USA
| | - Benjamin Ayres
- Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville, KY, USA
| | - David Cline
- Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville, KY, USA
| | - Brian Fiani
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, CA, USA
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Sari ND, Baltali S, Serin I, Antar V. Evaluation of Intraventricular/Intrathecal Antimicrobial Therapy in the Treatment of Nosocomial Meningitis Caused by Multidrug-Resistant Gram-Negative Bacteria after Central Nervous System Surgery. ACTA ACUST UNITED AC 2021; 2021:9923015. [PMID: 34497678 DOI: 10.1155/2021/9923015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 08/11/2021] [Accepted: 08/17/2021] [Indexed: 12/02/2022]
Abstract
Introduction Postoperative meningitis (POM) is an infection with high mortality and morbidity following central nervous system surgery due to trauma or tumor. Intrathecal/intraventricular (IT/IVT) antibiotic administrations have been considered as the last treatment options for multidrug-resistance (MDR) Gram-negative bacteria that do not respond to intravenous (IV) regimens. IT/IVT can bypass the blood-brain barrier, obtain a more effective antibiotic concentration in CSF, and reduce systemic side effects. We aimed to determine the characteristics of postoperative patients who were diagnosed with MDR POM during follow-up in our intensive care unit (ICU). Material and Methods. In this study, POM patients who were followed up in ICU after the central nervous system intervention between January 2016 and December 2019 and whose MDR Gram-negative bacteria were isolated from CSF were evaluated. As soon as the patients were diagnosed with POM, a catheter was inserted and treatment was started. Results Microbiological eradication was achieved in 3 ± 0.8 days with 30 mg/day amikacin treatment in POM due to K. pneumoniae and 3.7 ± 1.95 days with colistin sodium 10 mg/day treatment in POM due to A. baumannii via IT/IVT catheter. IT/IVT treatment was utilized for a median of 10 days and continued until the defined cure criteria were achieved. While cure was achieved in 6 of 14 POM cases, 8 of them were exitus. Discussion and Conclusion. To avoid the severe consequences of postoperative meningitis, acting fast and adding IT/IVT methods to parenteral administration routes by considering the distribution of MDR microorganisms within the hospital while planning effective treatment will increase the clinical success.
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Hsieh DY, Lai YR, Lien CY, Chang WN, Huang CC, Cheng BC, Kung CT, Lu CH. Sex-based differences in bacterial meningitis in adults: Epidemiology, clinical features, and therapeutic outcomes. J Infect Public Health 2021; 14:1218-25. [PMID: 34438332 DOI: 10.1016/j.jiph.2021.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/31/2021] [Accepted: 08/15/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND To investigate the sex-based differences in clinical features, causative pathogens, and outcomes of hospital-based culture-proven adult bacterial meningitis. OBJECTIVE This retrospective study enrolled 621 patients at a tertiary medical center. To compare changes over time, the presentation of disease among the enrolled patients was divided into two equal time periods: the first study period (1986-2002) and the second study period (2003-2019). RESULTS Of the 621 patients enrolled in this study, 396 were males and 225 were females. The overall case fatality rate was 30.4% with 30.1% and 31.1% in males and females, respectively. Regarding the causative pathogens, there was a rising incidence of coagulase-negative staphylococcal infections and a decreasing incidence of Klebsiella pneumoniae infection in both male and female in the second study period. The prevalence of patients with nosocomial infection in a postneurosurgical state were 41.9% (68/162) in the first study period and 58.1% (94/162) in the second study period in male group, and 34.8% (32/92) in the first study period and 65.2% (60/92) in the second study period in female group, respectively. Significant factors between the sexes difference included age (P = 0.004), traumatic brain injury (P = 0.01), alcoholism (P < 0.001), brain tumor (P < 0.001), systemic lupus erythematosus (SLE) (P = 0.004), presence of diabetic ketoacidosis/hyperglycemic hyperosmolar state (P = 0.033), brain abscess (P = 0.042), and total protein (P = 0.002) and white blood cell count (P = 0.036) of cerebrospinal fluid data. CONCLUSION Our study revealed an increase in the number of patients with nosocomial infection with a postneurosurgical state in both male and female in the second study period. Males were younger and frequently presented with a history of head trauma and alcoholism with concomitant brain abscesses while females presented with SLE and brain tumor. The therapeutic outcome did not show differences between the sexes.
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Figueiredo R, Pires Duro I, Marinho A, Mota C, Guedes M, Zilhão C. Granulomatosis with Polyangiitis in Adolescence: Two Distinct Presentations. Case Rep Rheumatol 2021; 2021:6642910. [PMID: 34239753 DOI: 10.1155/2021/6642910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 06/10/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction. Granulomatosis with polyangiitis (GPA) is a rare disease in pediatric age. We report two cases with distinct presentations. Case Reports. A seventeen-year-old male with prolonged febrile syndrome, cough, and constitutional symptoms. CT-scan showed cavitated lesions of the lung and bronchial biopsy a necrotizing inflammatory process. The remaining investigation revealed hematoproteinuria and positive C-ANCA and anti-PR3. Complications: Bilateral acute pulmonary thromboembolism, splenic infarction, and extensive popliteal and superficial femoral deep vein thrombosis. He was treated with corticosteroids, immunoglobulin, rituximab, and anticoagulation. Rituximab was maintained every six months during the first two years. Control angio-CT was performed with almost complete resolution of previous findings. In a twelve-year-old female with inflammatory signs of the limbs, investigation showed myositis of the thigh and tenosynovitis of the wrist, normocytic normochromic anemia (Hg 9.4 g/dL), mild elevation of inflammatory markers, and high creatine kinase. During hospitalization, she presented an extensive alveolar hemorrhage associated with severe anemia and positive C-ANCA and anti-PR3. Clinical deterioration prompted intravenous methylprednisolone pulses and plasmapheresis. Induction therapy with rituximab and prednisolone showed good results. Rituximab was maintained every six months, for 18 months, with gradual tapering of corticoids. Discussion. GPA is a systemic disease with variable clinical presentation and severity. Pediatric patients have similar clinical manifestations to adults but different frequencies of organ involvement; constitutional symptoms are also more common. We highlight the different presentation of these two cases, as well as the need for an individualized approach. Rituximab has been used for both induction-remission and maintenance therapy, with good results, particularly in young patients.
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Alvarez-Vega M, Boga JA, Fernandez-Suarez J, Martinez-Sela M, Moran-Suarez N, Rodríguez-Guardado A. Multidrug-resistant Acinetobacter meningitis in neurosurgical patients with intraventricular catheters: assessment of different treatments-authors' response. J Antimicrob Chemother 2021; 75:783-784. [PMID: 31977047 DOI: 10.1093/jac/dkz541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Marco Alvarez-Vega
- Neurosurgery Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - José A Boga
- Microbiology Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - María Martinez-Sela
- Internal Medicine Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Noelia Moran-Suarez
- Internal Medicine Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Azucena Rodríguez-Guardado
- Infectious Diseases Unit, Hospital Universitario de Cabueñes, Gijón, Spain and University of Oviedo, Oviedo, Spain
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Sahin A, Dalgic N, Kilic M, Kirgiz P, Kanik MK, Oz E, Yilmaz A. The role of intraventricular antibiotic therapy in the treatment of ventriculo-peritoneal shunt infection in children. Childs Nerv Syst 2021; 37:1605-12. [PMID: 33733692 DOI: 10.1007/s00381-021-05116-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND In this study, the effectiveness of intraventricular (IVT) antibiotic administration was evaluated in the treatment of ventriculo-peritoneal (VP) shunt infection by comparing patients who received only systemic antibiotic treatment with patients who received antibiotics added to systemic therapy by IVT route. METHODS From July 2009 to July 2019, 78 shunt infection episodes of 74 pediatric patients with bacterial growth in cerebrospinal fluid (CSF) culture who were treated with the diagnosis of VP shunt infection were retrospectively analyzed. The demographic data, clinical and laboratory parameters, antimicrobial management, and treatment outcomes of patients with VP shunt infections were recorded. RESULTS Thirty-eight of 78 shunt episodes received only systemic antibiotic treatment, and 40 had received IV plus IVT treatment. The mean age of the entire patient group was 16.7±21.3 months (range, 1 to 95 months). There was no significant difference between the two treatment groups in terms of mean age. The most common microorganism grown in CSF culture was coagulase-negative Staphylococcus. However, in the group that received IV plus IVT treatment, gram-negative bacteria were predominant (42.1% versus 20%), and this group had carbapenem-resistant and ESBL positive gram-negative bacteria growth. In the duration of CSF sterilization, hospital stay was statistically significantly shorter in the group receiving IV plus IVT treatment (p=0.000, p=0.000, respectively). CONCLUSION Our study shows that IVT administration of antibiotics shortens the duration of CSF sterilization, duration of antibiotic use, and the duration of hospital stay. For the treatment of VP shunt infection, the usage of IVT treatment in a particular group of a pediatric age is promising. However, further efforts should be done for supporting the current results by randomized controlled studies.
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Ma W, Li C, Cong L. Dynamic Curve Analysis of Indicators Related to Lumbar Cistern Drainage for Postoperative Meningitis. World Neurosurg 2021; 151:e299-e307. [PMID: 33872843 DOI: 10.1016/j.wneu.2021.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To analyze the dynamic curve of cerebrospinal fluid (CSF)-related indices in cases of postoperative meningitis after selective craniotomy and to provide reference data for the clinical treatment with lumbar cistern drainage (LCD). METHODS We conducted a retrospective study of LCD placement in 51 patients. Primary outcomes measured included dynamic changes of body temperature before and after intervention and cerebrospinal fluid biochemical parameters over the course of 13 days of catheter placement. We also assessed the bivariate correlation between white blood cell (WBC) count changes, polykaryocyte percentage, body temperature, and daily cerebrospinal fluid drainage volume. Finally, we analyzed the effect of average daily drainage volume, antibiotic choice, and surgical site on WBC count change curves. RESULTS After LCD, there was a statistically significant difference (P < 0.01) between the WBC count before drainage and on the fourth day of drainage. There was a negative correlation between the change curve of the WBC count and the change curve of daily drainage volume (r = -0.56). When the daily drainage volume was 250-300 mL/day, the change curve pattern of the WBC count was consistent with the overall trend, and there was no significant difference in the curve of the WBC count between different surgical sites (P > 0.05). CONCLUSIONS The WBC count can decrease significantly by day 4 after drainage, and placement of the LCD for 6-7 days is ideal. An average drainage volume of 250-300 mL/day is safe and effective.
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Affiliation(s)
- Weining Ma
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Chun Li
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Lin Cong
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China.
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Abstract
PURPOSE OF REVIEW We have highlighted the recent advances in infection in neurocritical care. RECENT FINDINGS Central nervous system (CNS) infections, including meningitis, encephalitis and pyogenic brain infections represent a significant cause of ICU admissions. We underwent an extensive review of the literature over the last several years in order to summarize the most important points in the diagnosis and treatment of severe infections in neurocritical care. SUMMARY Acute brain injury triggers an inflammatory response that involves a complex interaction between innate and adaptive immunity, and there are several factors that can be implicated, such as age, genetic predisposition, the degree and mechanism of the injury, systemic and secondary injury and therapeutic interventions. Neuroinflammation is a major contributor to secondary injury. The frequent and challenging presence of fever is a common denominator amongst all neurocritical care patients.
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Affiliation(s)
- Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital
- Department of Clinical Medicine, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Hospital Clinic, IDIBAPS, Universidad de Barcelona, Ciberes, Barcelona, Spain
| | - Alan Blake
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital
| | - Daniel Collins
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital
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Perdigão Neto LV, Medeiros M, Ferreira SC, Nishiya AS, de Assis DB, Boszczowski Ĺ, Costa SF, Levin AS. Polymerase chain reaction targeting 16S ribosomal RNA for the diagnosis of bacterial meningitis after neurosurgery. Clinics (Sao Paulo) 2021; 76:e2284. [PMID: 33503188 PMCID: PMC7811837 DOI: 10.6061/clinics/2021/e2284] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/26/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Bacterial and aseptic meningitis after neurosurgery can present similar clinical signs and symptoms. The aims of this study were to develop and test a molecular method to diagnose bacterial meningitis (BM) after neurosurgery. METHODS A 16S ribosomal RNA gene PCR-based strategy was developed using artificially inoculated cerebrospinal fluid (CSF) followed by sequencing. The method was tested using CSF samples from 43 patients who had undergone neurosurgery and were suspected to suffer from meningitis, and from 8 patients without neurosurgery or meningitis. Patients were classified into five groups, confirmed BM, probable BM, possible BM, unlikely BM, and no meningitis. RESULTS Among the samples from the 51 patients, 21 samples (41%) were culture-negative and PCR-positive. Of these, 3 (14%) were probable BM, 4 (19%) were possible BM, 13 (62%) were unlikely BM, and 1 (5%) was meningitis negative. Enterobacterales, non-fermenters (Pseudomonas aeruginosa and Acinetobacter baumannii), Staphylococcus haemolyticus, Granulicatella, Variovorax, and Enterococcus cecorum could be identified. In the group of patients with meningitis, a good agreement (3 of 4) was observed with the results of cultures, including the identification of species. CONCLUSION Molecular methods may complement the diagnosis, guide treatment, and identify non-cultivable microorganisms. We suggest the association of methods for suspected cases of BM after neurosurgery, especially for instances in which the culture is negative.
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Affiliation(s)
- Lauro Vieira Perdigão Neto
- Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, BR
- Laboratorio de Investigacao Medica 49, Bacteriologia, Sao Paulo SP, BR
- Departamento de Controle de Infeccao, Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Micheli Medeiros
- Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, BR
- Laboratorio de Investigacao Medica 49, Bacteriologia, Sao Paulo SP, BR
| | - Suzete Cleusa Ferreira
- Departamento de Biologia Molecular, Fundacao Pro-Sangue / Hemocentro de Sao Paulo, Sao Paulo, SP, BR
- Laboratorio de Investigacao Medica em Patogenese e Terapia dirigida em Onco-Imuno-Hematologia (LIM-31), Departamento de Hematologia, Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, SP, BR
| | - Anna Shoko Nishiya
- Departamento de Biologia Molecular, Fundacao Pro-Sangue / Hemocentro de Sao Paulo, Sao Paulo, SP, BR
- Laboratorio de Investigacao Medica em Patogenese e Terapia dirigida em Onco-Imuno-Hematologia (LIM-31), Departamento de Hematologia, Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, SP, BR
| | - Denise Brandão de Assis
- Departamento de Controle de Infeccao, Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, SP, BR
| | - ĺcaro Boszczowski
- Departamento de Controle de Infeccao, Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, SP, BR
| | - Silvia Figueiredo Costa
- Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, BR
- Laboratorio de Investigacao Medica 49, Bacteriologia, Sao Paulo SP, BR
- Departamento de Controle de Infeccao, Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, SP, BR
| | - Anna S. Levin
- Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, BR
- Laboratorio de Investigacao Medica 49, Bacteriologia, Sao Paulo SP, BR
- Departamento de Controle de Infeccao, Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, SP, BR
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Abstract
Introduction: Healthcare-associated ventriculitis and meningitis occur after neurosurgical procedures, is associated with an adverse outcome in the majority of patients and represent a diagnostic challenge to clinicians. As the cerebrospinal fluid (CSF) culture is the cornerstone of diagnosis, obtaining CSF studies prior to starting antibiotic therapy is key.Areas covered: This review will evaluate the incidence, risk factors, clinical presentation, diagnosis, empirical intravenous antibiotic therapy, adjunctive intrathecal therapy, microbiology, prognosis, and prevention of HCAVM. We highlight the challenges and limitations of the currently available diagnostic methods and definitions and explore novel technologies. Our review included the search for published literature until June 2020.Expert opinion: Despite available preventive measures, HCAVM continues to occur and to be independently associated with significant neurological morbidity and mortality in the majority of patients. The cornerstone of the diagnosis of HCAVM is a positive CSF culture but the microbiological yield is reduced to ~50% with prior antimicrobial therapy. Although the CSF profile is not affected by antibiotic therapy it has a fair diagnostic accuracy. Future research efforts should concentrate in identifying novel diagnostic tools such as polymerase chain reaction (PCR) or metagenomic sequencing.
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Affiliation(s)
- Rodrigo Hasbun
- Professor of Medicine, McGovern Medical School UT Health, Houston, TX, USA
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Abstract
Lactate is produced from anaerobic glycolysis, which occurs in most tissues in the human body. Blood lactate is tested in most physiologically unwell patients in the Emergency Department and helps to guide treatment and prognosis. Cerebrospinal fluid (CSF) lactate, however, is not often measured. Various central nervous system (CNS) conditions lead to a rise in CSF lactate, including acute neurological infection, stroke, seizures and mitochondrial pathologies. This article discusses the utility and limitations of CSF lactate, highlighting specific clinical situations where it can help in the diagnosis of CNS infections and unexplained encephalopathy.
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Mathy V, Chousterman B, Munier A, Cambau E, Jacquier H, Péan de Ponfilly G. First Reported Case of Postneurosurgical Ventriculoperitonitis Due to Kocuria rhizophila Following a Ventriculoperitoneal Shunt Placement. Infect Dis Clin Pract 2020; 28:169-70. [DOI: 10.1097/ipc.0000000000000829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
PURPOSE OF REVIEW Management of patients with meningitis and encephalitis oftentimes requires ICU level of care. This article is an update on management for meningitis and encephalitis with focus on clinical care in the ICU. Information provided is based on a review of recent studies with focus on studies since 2017. RECENT FINDINGS Advances in diagnostic and treatment approach for different pathogens are presented. Nosocomial meningitis now constitutes a major part of brain infections seen in ICUs in the developed world. Advances in ICU care of central nervous system (CNS) infections include application of newer diagnostic methods, improved understanding and delivery of antibiotics to the CNS, infection prevention for nosocomial infections, and application of neuromonitoring where indicated. SUMMARY Advances in diagnostics and therapeutic approach to CNS infections are continually made. For intensivists, focus on neuromonitoring and brain resuscitation in critically ill patients with CNS infections may present a path to enhance preservation of brain function and improve outcomes. VIDEO ABSTRACT: http://links.lww.com/COCC/A22.
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Ramakrishna JM, Libertin CR, Yang JN, Diaz MA, Nengue AL, Patel R. 16S rRNA Gene PCR/Sequencing of Cerebrospinal Fluid in the Diagnosis of Post-operative Meningitis. Access Microbiol 2020; 2:acmi000100. [PMID: 34568757 PMCID: PMC8459102 DOI: 10.1099/acmi.0.000100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 12/17/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Post-operative meningitis (POM) is a life-threatening complication of neurosurgery. Diagnosis is often difficult due to pre-existing inflammation and antecedent antimicrobial use. Bacterial cerebrospinal fluid (CSF) cultures may reveal no growth, but empiric antibiotics are typically given due to the high morbidity and mortality associated with POM. 16S rRNA gene PCR/sequencing is a molecular methodology that can identify the presence of bacteria regardless of viability for culture. CASE PRESENTATION A patient presented with a rapid onset of fever associated with headache, neck pain, nausea and altered mental status 11 days after undergoing laser interstitial thermal therapy for treatment of recurrent astrocytoma at another hospital. Based on clinical presentation and imaging, POM was suspected, and empiric antibacterial therapy was started. Microbiological stains and cultures of CSF were negative. Due to persistent fevers, 16S rRNA gene PCR/sequencing was done on CSF; it detected a member of the order Enterobacteriales most closely resembling Serratia species. All antimicrobials were stopped except for cefepime, which was given for 2 weeks. The patient's mental status fully recovered. CONCLUSION The application of 16S rRNA gene PCR/sequencing in the setting of POM is of value by improving the quality of patient care and decreasing costs by antimicrobial de-escalation. Further studies regarding the positive and negative predictive values of this test are required.
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Affiliation(s)
| | | | - Joshua N Yang
- Division of Clinical Microbiology, Mayo Clinic, MN, USA
| | - Mark A Diaz
- Division of Infectious Diseases, Mayo Clinic, FL, USA
| | - Anne L Nengue
- Division of Infectious Diseases, Mayo Clinic, FL, USA
| | - Robin Patel
- Division of Clinical Microbiology, Mayo Clinic, MN, USA.,Division of Infectious Diseases, Mayo Clinic, MN, USA
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Yang W, Wu X, Li Z, Yuan Q, Wu G, Yu J, Wu X, Du Z, Hu J, Zhou L. Trends of Intra-Cranial Bacterial Infection in Patients Requiring Emergency Neurosurgery. Surg Infect (Larchmt) 2020; 21:677-683. [PMID: 31944897 DOI: 10.1089/sur.2019.317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Intra-cranial bacterial infection is a serious complication in emergency neurosurgical patients, and few data are available on the trends of these infections and the rates of antibacterial drug resistance. Methods: We surveyed retrospectively the patients with intra-cranial bacterial infection in our emergency neurosurgical center between January 2009 and December 2018. Demographic characteristics, causative bacteria, and antimicrobial susceptibility test results were collected. Results: A total of 100 patients with intra-cranial bacterial infection, 1.41% of our patients, were enrolled. There were 123 strains of bacteria cultured from the cerebrospinal fluid (CSF), consisting of 96 strains of gram-negative (GN) bacteria and 27 strains of gram-positive (GP) bacteria. Compared with the GP bacteria, the percentage of GN bacteria increased to 75.0% of the total near the end of the study. Compared with Acinetobacter baumannii, Klebsiella pneumoniae also showed an uptrend. Most of the bacteria were multi-drug-resistant (MDR). We further analyzed the consistency of CSF and sputum cultures from the same patient. The ratio of Klebsiella pneumoniae and Acinetobacter baumannii to the corresponding strains in the CSF were 77.0% and 62.0%. Conclusions: The bacteria recovered from the CSF were mainly GN. The tendency of GN bacteria showed an uptrend, especially for Klebsiella pneumoniae. Furthermore, most of the bacteria were MDR.
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Affiliation(s)
- Weijian Yang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xing Wu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhiqi Li
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qiang Yuan
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Gang Wu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jian Yu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xuehai Wu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhuoying Du
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jin Hu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Liangfu Zhou
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
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Abstract
PURPOSE The utility of endoscopic endonasal skull base surgery (EES) in various pathologic entities in adults has been published in the literature. However, the role of EES in children has not been clearly elucidated. We evaluated the feasibility of EES in children with brain tumors. METHODS We retrospectively reviewed clinical features, surgical outcomes, and complications in children who underwent EES for intracranial and skull base tumors at a single institution from July 2010 to October 2018. RESULTS A total of 82 patients underwent EESs for 77 intracranial and 5 skull base bony tumors. The mean age at diagnosis was 11.4 years (range 4-18 years), and the mean follow-up period was 46.8 months. The most common tumors were craniopharyngioma in the intracranial tumor and chordoma in the skull base. Gross total resection was the goal of surgery in 55 patients and achieved in 90.9%. The vision was improved in 76.1% of patients with visual impairments. Preoperatively, various endocrinological deficiencies were revealed in 73.7% of 76 patients with hypothalamus-pituitary lesions, and the hyposomatotropism was most common. Endocrinological status was improved only in 10. Aseptic or bacterial meningitis (7.3%) was the most common surgical complication, and the cerebrospinal fluid leakage rate was 2.4%. CONCLUSIONS EES provides favorable neurological outcomes with acceptable risk for children with brain tumors. The high incidence of endocrinological deficits in cases with hypothalamus-pituitary lesions emphasizes the importance of judicious pre- and postoperative evaluation.
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Affiliation(s)
- Yong Hwy Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji Yeoun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.,Division of Pediatric Neurosurgery, Department of Neurosurgery, Seoul National University Children's Hospital, College of Medicine, Seoul National University, Seoul, Republic of Korea.,Department of Anatomy, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Ji Hoon Phi
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.,Division of Pediatric Neurosurgery, Department of Neurosurgery, Seoul National University Children's Hospital, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Kyu-Chang Wang
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.,Division of Pediatric Neurosurgery, Department of Neurosurgery, Seoul National University Children's Hospital, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Seung-Ki Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea. .,Division of Pediatric Neurosurgery, Department of Neurosurgery, Seoul National University Children's Hospital, College of Medicine, Seoul National University, Seoul, Republic of Korea.
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49
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Abstract
PURPOSE OF REVIEW This article summarizes updated data and knowledge on healthcare-associated infections in the neurocritical care unit, with a focus on central nervous system infections and systemic infectious complications in patients with acute brain disease. It also reviews the concept of brain injury-induced immune modulation, an underlying mechanism to explain why the neuro-ICU population is particularly susceptible to infections. RECENT FINDINGS Healthcare-associated infections in the neuro-ICU are common: up to 40 % of meningitides in the developed world are now healthcare-associated. The number of gram-negative infections is rising. New diagnostic approaches attempt to aid in the diagnosis of healthcare-associated meningitis and ventriculitis. Healthcare-associated infections in the neurocritical care unit remain a challenge for diagnosis, treatment, and prevention. Gaining a better understanding of at-risk patients and development of preventative strategies will be the goal for future investigation.
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Affiliation(s)
- Katharina M Busl
- Departments of Neurology and Neurosurgery, McKnight Brain Institute L3-100, University of Florida College of Medicine, 1149 Newell Drive, Gainesville, FL, 32610, USA.
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50
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Affiliation(s)
- Yue Chen
- Center of Clinical Pharmacy, Chinese PLA General Hospital, Beijing, China
| | - Lei Liu
- Neurosurgery Department, Chinese PLA General Hospital, Beijing, China
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