Intrathecal or intraventricular antimicrobial therapy for post-neurosurgical intracranial infection due to multidrug-resistant and extensively drug-resistant Gram-negative bacteria: A systematic review and meta-analysis

Hu, Yangmin; He, Wei; Yao, Difei; Dai, Haibin

doi:10.1016/j.ijantimicag.2019.08.002

Cited by 22 publications

(20 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 19 Patients with post-neurosurgical intracranial infection due to MDR/XDR Gram-negative bacteria have been shown in observational studies to benefit from the addition of ITH/IVT antimicrobial therapy, which is associated with a lower risk of mortality and a higher microbiological clearance rate and only mild adverse effects. 23 The current standard of care for MDR/XDR A. baumannii ventriculitis/meningitis is IVT/ITH colistin, which provides a novel, relatively safe, and effective form of therapy. 27 Therefore, IVT polymyxin B may be an effective treatment for CNS infections with MDR/XDR Gram-negative bacteria.…”

Section: Discussionmentioning

confidence: 99%

“…[20][21][22] Unfortunately, IVT polymyxin B is often used as a remedial treatment but is not recommended as an initial treatment for carbapenem-resistant MDR/XDR Gram-negative bacilli, and there have been few clinical studies on the correlation between the timing of IVT polymyxin administration and mortality. 23 The IDSA guidelines also do not provide a possible effective start time window for IVT polymyxin B. This study aimed to determine the efficacy and administration time of IVT polymyxin B in the treatment of carbapenem-resistant and MDR/ XDR Gram-negative bacilli in CNS infections and to investigate prognostic factors.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Treatment of Carbapenem-Resistant Multidrug-Resistant Gram-Negative Bacilli with Intracerebroventricular Injection of Polymyxin B: A Retrospective Study

Liu¹,

Niu²,

Chen³

et al. 2022

IDR

View full text Add to dashboard Cite

Purpose We evaluated the efficacy and administration time of intraventricular (IVT) polymyxin B in the treatment of carbapenem-resistant and multidrug-resistant/extensively drug-resistant (MDR/XDR) Gram-negative bacilli in central nervous system (CNS) infections and investigated prognostic factors. Patients and Methods This retrospective analysis comprised 41 post-surgical carbapenem-resistant CNS infections from October 2016 to October 2021. All patients were treated with effective intravenous antibiotics and IVT polymyxin B. Patient characteristics, therapeutic procedure, symptoms, cerebrospinal fluid (CSF) examination, laboratory tests, and complications were recorded. The effectiveness of IVT polymyxin B was evaluated using temperature, Glasgow Coma Scale, CSF contents, bacterial clearance rate, cure rate, and mortality. Mortality between early (7 days) and late administration of IVT polymyxin B was compared. Prognostic factors were evaluated using the pupillary light reflex and multiloculated hydrocephalus. Results The 41 patients acquired carbapenem-resistant MDR/XDR bacteria, including 24 Klebsiella pneumoniae , 15 Acinetobacter baumannii , 3 Pseudomonas aeruginosa , and 1 Enterobacter cloacae . The bacterial clearance rate was 32/41 (78.0%), and 9 patients (22.0%) with uncured bacterial infections died. Adverse events included 1 case of skin pigmentation. Among the 32 cured patients, 31 received a ventriculoperitoneal shunt, and 1 patient had an extraventricular drainage tube removed. Mortality in the late (>7 days) group was higher (39.1% vs 0%, P < 0.05). The group without pupillary light reflex showed a higher death rate (41.2% vs 8.3%; P < 0.05). The multiloculated hydrocephalus group had a higher mortality rate than that of the normal group (34.8% vs 5.6%, P < 0.05). All 32 cured patients were followed up for 9 to 66 months, and all survived without recurrent infections. Conclusion Intraventricular polymyxin B is an effective treatment for carbapenem-resistant MDR/XDR Gram-negative bacilli, with a 78% cure rate and significant mortality reduction if administered within 7 days of bacterial identification. Multiloculated hydrocephalus and the pupillary light reflex may be used as prognostic indicators of mortality.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Treatment of Carbapenem-Resistant Multidrug-Resistant Gram-Negative Bacilli with Intracerebroventricular Injection of Polymyxin B: A Retrospective Study

Liu¹,

Niu²,

Chen³

et al. 2022

IDR

View full text Add to dashboard Cite

show abstract

“… 11 The isolation of MDROs from the CSF samples of patients complicates the treatment procedure and amounts to higher mortality among the patients. 12 This study takes into account the spectrum of MDROs among the postoperative patients and the risk factors like the use of shunts that lead to the acquisition of drug resistance.…”

Section: B Ackgroundmentioning

confidence: 99%

Bacterial Meningitis among Intracranial Surgery Patients at a University Hospital in Northern India

Sahu¹,

Patel²,

Kar³

et al. 2022

Indian Journal of Critical Care Medicine

View full text Add to dashboard Cite

A bstract Background Cerebrospinal infections are the cause of poor prognosis among post-neurosurgery patients owing to delay in improvement of neurological functions, leading to increased length of hospital stay, proceeding to disability or death. Methods and materials This retrospective observational study was performed at a tertiary care center in Northern India, where all patients with bacterial cerebrospinal infections from July 2019 to July 2022 were evaluated for post-neurosurgery cerebrospinal shunt infections, and all demographic data and risk factors were extracted from the hospital information system (HIS). Results The study includes 150 (150/1986, 7.55%) culture-confirmed cases of bacterial meningitis out of 1986 cases of suspected bacterial meningitis patients. Ninety-six (96/150, 64.0%) post-neurosurgery patients with cerebrospinal fluid (CSF) leaks were managed using external ventricular drain (EVD) or ventriculoperitoneal (VP) shunt. Seventy-four (74/96, 77.08%) patients were managed only on EVD, whereas 22 (22/96, 22.92%) patients were managed only on VP shunt. Eighty-two (82/96, 85.4%) multidrug-resistant microorganisms (MDROs) were isolated and 70 (70/82, 85.36%) were gram-negative bacteria, of which 56 (56/74, 75.68%) gram-negative bacteria showed extended-spectrum beta-lactamase (ESBL)-producing character in those with an EVD, 14 (14/22, 63.63%) with a VP shunt. Among gram-negative bacteria, Acinetobacter baumannii showed high rates of resistance: 21 (21/23, 91.30%) and 8 (8/8, 100%) were ESBL-producing A. baumannii in patients managed on EVD and VP shunt, respectively. Conclusion This study determines the risk factors, the spectrum of pathogenic microorganisms, multidrug resistance, and the nature of intracranial lesions isolated among the patients who developed bacterial cerebrospinal infections in post-neurosurgery patients. How to cite this article Kar M, Jamwal A, Dubey A, Sahu C, Patel SS. Bacterial Meningitis among Intracranial Surgery Patients at a University Hospital in Northern India. Indian J Crit Care Med 2022;26(12):1244–1252.

show abstract

“…The rate of mortality is higher in patients with Gram-negative bacterial intracranial infections and MDR Gram-negative agents have also more complicated treatment process. A. baumannii, Klebsiella pneumoniae (K. pneumoniae) , and Pseudomonas aeruginosa (P. aeruginosa) are the most common MDR Gram-negative agents [ 10 , 11 ]. Against MDR or extensively drug-resistant (XDR) Gram-negative bacteria, there are only a few drugs such as polymyxins and aminoglycosides; however, due to low brain penetration, intracranial infection does not show any improvement even when treated with these antimicrobial agents.…”

Section: Introductionmentioning

confidence: 99%

“…IT/IVT can bypass the blood-brain barrier, obtain a more effective antibiotic concentration in CSF, and reduce systemic side effects [ 12 ]. Potential neurotoxicity such as chemical meningitis and ventriculitis cannot be ignored, but these reactions have been reported to be mild and also reversible [ 10 , 12 ]. The most commonly used IT/IVT agents are aminoglycosides (gentamycin, tobramycin, netilmicin, amikacin, and streptomycin), polymyxins (colistin and polymyxin B), daptomycin, glycopeptides (vancomycin and teicoplanin), tigecycline, and antifungal agents such as amphotericin B and caspofungin [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Intraventricular/Intrathecal Antimicrobial Therapy in the Treatment of Nosocomial Meningitis Caused by Multidrug-Resistant Gram-Negative Bacteria after Central Nervous System Surgery

Sari¹,

Baltalı²,

Serin³

et al. 2021

Canadian Journal of Infectious Diseases and Medical Microbiolog

View full text Add to dashboard Cite

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.

show abstract

Intrathecal or intraventricular antimicrobial therapy for post-neurosurgical intracranial infection due to multidrug-resistant and extensively drug-resistant Gram-negative bacteria: A systematic review and meta-analysis

Cited by 22 publications

References 28 publications

Treatment of Carbapenem-Resistant Multidrug-Resistant Gram-Negative Bacilli with Intracerebroventricular Injection of Polymyxin B: A Retrospective Study

Treatment of Carbapenem-Resistant Multidrug-Resistant Gram-Negative Bacilli with Intracerebroventricular Injection of Polymyxin B: A Retrospective Study

Bacterial Meningitis among Intracranial Surgery Patients at a University Hospital in Northern India

Evaluation of Intraventricular/Intrathecal Antimicrobial Therapy in the Treatment of Nosocomial Meningitis Caused by Multidrug-Resistant Gram-Negative Bacteria after Central Nervous System Surgery

Contact Info

Product

Resources

About