Hyperbaric oxygen treatment: Results in seven patients with severe bacterial postoperative central nervous system infections and refractory mucormycosis

Abstract

Introduction: Resistant bacterial infections following brain and spine surgery and spontaneous mucormycosis with central nervous system (CNS) involvement represent a serious treatment challenge and more efficient therapeutic approaches ought to be considered. Hyperbaric oxygen treatment (HBOT) has shown promise as a complementary therapy. This case series evaluated whether HBOT contributed to infection resolution in seven patients with refractory CNS infectious conditions. Methods: Clinical results for seven patients referred for HBOT between 2010 to 2018 to treat refractory postoperative brain and spine infections or spontaneously developing mucormycosis were retrospectively analysed. The patients’ clinical files and follow-up consultations were reviewed to assess evolution and outcome. Results: Seven patients were referred with a median age of 56 years. The median follow-up was 20 months. Four patients had postoperative infections and three had rhino-orbital-cerebral mucormycosis (ROCM). HBOT was used as an adjunctive treatment to antimicrobial therapy in all patients. Prior to HBOT, all patients had undergone an average of four operations due to infection refractoriness and had completed an average of five months of antimicrobial therapy. After HBOT, infection resolution was obtained in six patients without additional operations, while one patient with ROCM stopped HBOT after the third session due to intolerance. Three patients stopped antimicrobial therapy while four were maintained on prophylactic treatment. Conclusions: Infection resolution was reached in the six patients that completed HBOT as prescribed. HBOT may serve as an effective complementary treatment in CNS refractory postoperative and spontaneous infections.

Mucormycosis in Indian COVID-19 Patients: Insight into Its Patho-Genesis, Clinical Manifestation, and Management Strategies

“…Popular adjunctive therapies include hyperbaric oxygen, immunomodulation strategies, and iron chelation [ 89 ]. Hyperbaric oxygen, which is an effective treatment for diabetic patients who have rhinocerebral or severe cutaneous mucormycosis [ 121 ], increases the partial pressure of oxygen and improves neutrophilic function. High oxygen concentrations also improve wound healing by releasing enhanced tissue growth factors [ 122 ].…”

Oxigenoterapia hiperbárica como tratamiento complementario en mucormicosis asociada a COVID-19: a propósito de dos casos

“…Los mecanismos de acción de la TOHC en enfermedades infecciosas son: a) mejora la actividad fagocítica de leu-cocitos dependientes de oxígeno (11,14,15) ; b) corrige la acidosis láctica favoreciendo la acción oxidativa de la anfotericina B (11,14) ; y c) favorece la reparación tisular (10,11,15) por activación de fibroblastos y neovascularización por incremento de factores de crecimiento (9)(10)(11)15) . Por lo tanto, se describe su uso en las infecciones necrotizantes de tejidos blandos como: fascitis necrotizante, gangrena gaseosa, osteomielitis refractaria crónica y ulceras de pie diabético (11,15) . La TOHC es usualmente bien tolerada, con bajo riesgo de eventos adversos (9) .…”

“…HBOT has the following effects on infectious diseases: a) it improves the phagocytic activity of oxygen-dependent leukocytes 11 , 14 , 15 ; b) it corrects lactic acidosis by favoring the oxidative action of amphotericin B 11 , 14 ; and c) it favors tissue repair 10 , 11 , 15 by activation of fibroblasts and neovascularization due to an increase in growth factors 9 - 11 , 15 . Therefore, it has been used in cases of necrotizing soft tissue infections such as necrotizing fasciitis, gas gangrene, chronic refractory osteomyelitis and diabetic foot ulcers 11 , 15 . HBOT is usually well tolerated, with low risk of adverse events 9 .…”

Rhino-Orbital Cerebral Mucormycosis: A Fatal Evolution

“…Adjuvant treatment may help to limit local extension and increase the chance of recovery. It includes functional endoscopic sinus surgery, retrobulbar and intravitreal injection of amphotericin B, and hyperbaric oxygenation because of its fungistatic role and its role in the neovascularization of ischemic territories [17][18][19]. In addition to the absence of surgical treatment and the delay in diagnosis, other factors of poor prognosis have been identified in the literature, such as neurological involvement, the presence of facial necrosis, and hyperglycemia [3,6].…”