Brain stem and lower cranial nerve function were the main factors affecting extubation decision-making. Further research is required, to establish criteria for delayed extubation following infratentorial craniotomy.

BackgroundTo identify changes in cefoperazone/sulbactam penetration into cerebrospinal fluid (CSF) after craniotomy and to investigate preliminarily whether cefoperazone/sulbactam CSF concentration can reach therapeutic level when administered intravenously after neurosurgical operation.MethodsNeurosurgical patients with an indwelling ventricular drainage pipe who received prophylactic cefoperazone/sulbactam for the treatment of intracranial infection were received a cefoperazone/sulbactam 2:1, 3.0-g infusion for 3 hours every 6 hours for 24 h. Venous blood and CSF specimens were collected to determine cefoperazone/sulbactam concentrations.ResultsThe cefoperazone and sulbactam concentrations in serum were highest at the second hour (237.54±336.72 mg/L and 66.52±80.38 mg/L, respectively) and then decreased. The cefoperazone and sulbactam concentrations in CSF were highest at the 4th hour (39.22±75.55 mg/L and 6.24±8.35 mg/L, respectively) and then decreased. CSF penetration measured by the ratio of peak concentrations (CSF/serum) was 8.6%±7.2% for cefoperazone and 13.5%±11.9% for sulbactam, CSF penetration measured by the ratio of trough concentrations (CSF/serum) was 13.4%±5.3% for cefoperazone and 106.5%±87.5% for sulbactam. CSF penetration represented by the ratio of area under the curve (AUC) of CSF and serum was 14.5% for cefoperazone and 22.6% for sulbactam. Neurosurgical impairment of the blood–brain barrier may improve the CSF penetration of these drugs, but it is difficult to reach the MIC90 of resistant bacteria. If single intravenous administration time was extended to 3 hours, the serum concentrations of drugs were able to meet the PK/PD standard (T> MIC%> 50%) for treating common, highly resistant bacteria.ConclusionsThe CSF penetration of cefoperazone/sulbactam may be enhanced after neurosurgical impairment of the blood–brain barrier. This study is a pilot research of cefoperazone/sulbactam using in neurosurgical individuals, However, it needs to be confirmed by further large-scale studies.

A Gram-stain negative, non-flagellated, facultatively anaerobic, slightly halophilic bacterium, WNB302, was isolated from a marine solar saltern in Wendeng, China (122°0'38.85″E, 36°57'56.49″N). Cells of strain WNB302 were 0.2-0.7 µm wide and 2.0-10.0 µm long, catalase- positive and oxidase-negative. Colonies were opaque, orange and approximately 1.0-2.0 mm in diameter after culture for 96 h on marine agar 2216. Growth occurs at 15-37 °C (optimum, 33-35 °C), pH 6.0-8.5 (optimum, pH 7.0-7.5), and with 0.5-7% NaCl (optimum, 2-3% NaCl). Phylogenetic analysis based on 16S rRNA gene sequences showed that strain WNB302 belongs to the genus Winogradskyella and is closely related to Winogradskyella exilis KCTC 32356. Strain WNB302 exhibited 96.2 and 96.0% 16S rRNA gene sequence similarities with W. exilis KCTC 32356 and W. litoriviva KCTC 23972. Average nucleotide identity (ANI) value based on draft genomes between strain WNB302 and Winogradskyella thalassocola KCTC 12221 showed a relatedness of 81.1% (with 93.7% of 16S rRNA gene sequence similarity). The major respiratory quinone of strain WNB302 was found to be MK-6, and the dominant fatty acids were found to be iso-C and iso-C G. The major polar lipids of strain WNB302 were three unidentified lipids (L1, L2 and L3), one unidentified aminolipids (AL1) and phosphatidylethanolamine (PE). The genomic DNA G+C content was 37.0 mol%. On the basis of the data presented, strain WNB302 is considered to represent a novel species of the genus Winogradskyella, for which the name Winogradskyella aurantia sp. nov. is proposed. The type strain is WNB302 (= KCTC 52614 = MCCC 1H00172).