Carbapenem-Resistant Gram-Negative Bacteria-Related Healthcare-Associated Ventriculitis and Meningitis: Antimicrobial Resistance of the Pathogens, Treatment, and Outcome

Ye, Yi; Kong, Yueyue; Ma, Jiawei; Shi, Guangzhi

doi:10.1128/spectrum.00253-22

Cited by 7 publications

(8 citation statements)

References 22 publications

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“…The reason why maybe that only 9 patients with intracranial infection were enrolled in our study. In a study by Ye Y et al involving 91 patients with carbapenem-resistant Gram-negative bacteria-related health careassociated ventriculitis and meningitis for 9 years, therapies of polymyxin and meropenem/sulbactam were considered optional choices 22 . Sun L et al reported that ampicillin-sulbactam may be an effective therapeutic agent for meningitis caused by Acinetobacter baumannii resistant to imipenem and other βlactam medication 23 .…”

Section: Discussionmentioning

confidence: 99%

A retrospective study of the efficacy of sulbactam in the treatment of patients with extensively drug-resistant Acinetobacter baumannii infections

Yu,

Zhang,

Yang

et al. 2024

Preprint

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Purpose Sulbactam (SBT) is one of the most significant treatments for patients with extensively drug-resistant Acinetobacter baumannii (XDR-AB). However, the efficacy and safety of SBT and its high dose regimen has not been well documented. This retrospective study aimed to assess the efficacy and safety of SBT-based treatment, particularly at high-dose (≥ 6g/day), for XDR-AB infection. Method A total of 52 XDR-AB infected patients treated with intravenous SBT at Peking Union Medical College Hospital were included. The primary outcome was 28-day all-cause mortality, while the secondary outcome was 14-day clinical response and the time of response. Results Among the patients, the 28-day all-cause mortality rate was 36.5% (19/52), and the favorable 14-day clinical response rate was 59.6% (31/52). The 28-day mortality was independently associated coinfection with gram-positive bacteria (GPB) and a shorter duration of therapy. Patients with intracranial infection might have a longer survival time. A favorable 14-day clinical response was associated with high dose SBT, and a longer treatment duration. However, the higher creatinine clearance (CrCl) associated with a worse clincal response. In addition, a higher SBT dosage was significantly correlated with a quicker clinical response. No adverse effects related were reported. Conclusion The single-agent formulation of SBT emerges as a promising alternative for the treatment of XDR-AB infection, such as intracranial infection, particularly at high doses (≥ 6g/day). Besides, longer duration of treatment correlates with higher survival rate and better favorable clinical response. Higher CrCl negatively correlates with favorable clinical response.

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Section: Discussionmentioning

confidence: 99%

A retrospective study of the efficacy of sulbactam in the treatment of patients with extensively drug-resistant Acinetobacter baumannii infections

Yu,

Zhang,

Yang

et al. 2024

Preprint

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“…CRGNB is associated with increased mortality [ 23 ]. CRAB has become the most common pathogen for nosocomial intracranial infection neurosurgery wards [ 5 , 24 ]. A retrospective study showed that the 30-day mortality of postoperative CNS infection caused by MDR/XDR A. baumannii was 28.6%, even after IVT/ITH administration [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Intraventricular or intrathecal polymyxin B for treatment of post-neurosurgical intracranial infection caused by carbapenem-resistant gram-negative bacteria: a 8-year retrospective study

Hu,

Li,

Zhang

et al. 2024

Eur J Clin Microbiol Infect Dis

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Purpose Post-neurosurgical intracranial infection caused by carbapenem-resistant gram-negative bacteria (CRGNB) is a life-threatening complication. This study aimed to assess the current practices and clinical outcomes of intravenous (IV) combined with intraventricular (IVT)/intrathecal (ITH) polymyxin B in treating CRGNB intracranial infection. Methods A retrospective study was conducted on patients with post-neurosurgical intracranial infection due to CRGNB from January 2013 to December 2020. Clinical characteristics and treatment outcomes were collected and described. Kaplan–Meier survival and multivariate logistic regression analyses were performed. Results The study included 114 patients, of which 72 received systemic antimicrobial therapy combined with IVT/ITH polymyxin B, and 42 received IV administration alone. Most infections were caused by carbapenem-resistant Acinetobacter baumannii (CRAB, 63.2%), followed by carbapenem-resistant Klebsiella pneumoniae (CRKP, 31.6%). Compared with the IV group, the IVT/ITH group had a higher cerebrospinal fluid (CSF) sterilization rate in 7 days (p < 0.001) and lower 30-day mortality (p = 0.032). In the IVT/ITH group, patients with CRKP infection had a higher initial fever (p = 0.014), higher incidence of bloodstream infection (p = 0.040), lower CSF sterilization in 7 days (p < 0.001), and higher 30-day mortality (p = 0.005) than those with CRAB infection. Multivariate logistic regression analysis revealed that the duration of IVT/ITH polymyxin B (p = 0.021) was independently associated with 30-day mortality. Conclusions Intravenous combined with IVT/ITH polymyxin B increased CSF microbiological eradication and improved clinical outcomes. CRKP intracranial infections may lead to more difficult treatment and thus warrant attention and further optimized treatment.

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“…A recent study has shown that mortality is high (61%) with no significant difference between infections caused by Gram-positive or Gram-negative organisms [16]. A timely initiation of treatment of healthcare-associated CNS infections is crucial but there is also an urgent need to limit ineffective treatments, which were recently reported to have been prescribed in as many as 46% of cases [17]. Indeed, in addition to the direct risks, infections can also cause the obstruction of shunts or other devices, thus causing further deterioration of brain function.…”

Section: Common Causes and Therapeutical Approachesmentioning

confidence: 99%

Healthcare-associated central nervous system infections

Ippolito

Giarratano

Cortegiani

2022

Current Opinion in Anaesthesiology

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Purpose of reviewThe aim of this review is to provide a practical and updated summary on healthcare-associated central nervous system infections and their management. Recent findingsThe term 'healthcare-associated ventriculitis and meningitis' has recently been coined and clinical practical guidelines have been published on the management of these nosocomial infections. Many aspects have still to be further investigated (e.g. cerebrospinal fluid biomarkers, indications for novel antibiotics, intrathecal antimicrobial regimens). SummaryClinicians should maintain a high index of suspicion for healthcare-associated central nervous system infections in patients with specific risk factors (i.e. recent neurosurgery, cerebrospinal shunts, drains or implantable devices, head/spinal traumatic events), taking into account systemic signs, and alterations in microbiological, imaging, cerebrospinal fluid findings. The diagnosis is often difficult to confirm because of reduced levels of consciousness or coma. Both Gram-positive and Gram-negative (often multidrug-resistant or even pandrug-resistant) microorganisms may be the cause. Selection of antibiotics must consider susceptibility and penetration into the central nervous system. Ineffective treatments are frequent, and mortality can reach 60%. Future research should focus on the diagnostic performance of biomarkers and on the use of novel antimicrobial regimens, especially for the treatment of difficult to treat infections.

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Carbapenem-Resistant Gram-Negative Bacteria-Related Healthcare-Associated Ventriculitis and Meningitis: Antimicrobial Resistance of the Pathogens, Treatment, and Outcome

Cited by 7 publications

References 22 publications

A retrospective study of the efficacy of sulbactam in the treatment of patients with extensively drug-resistant Acinetobacter baumannii infections

A retrospective study of the efficacy of sulbactam in the treatment of patients with extensively drug-resistant Acinetobacter baumannii infections

Intraventricular or intrathecal polymyxin B for treatment of post-neurosurgical intracranial infection caused by carbapenem-resistant gram-negative bacteria: a 8-year retrospective study

Healthcare-associated central nervous system infections

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