&lt;p&gt;A Clinical Study on the Use of Intraventricular Polymyxin B Supplemented by Continuous External Ventricular Drainage in the Treatment of Drug-Resistant Gram-Negative Bacilli Intracranial Infection&lt;/p&gt;

Chen, Hongwei; Guo, Xiaocheng; Xie, Dongcheng; Dong, Xuanwei; Niu, Jianxing; Chen, Guoqiang

doi:10.2147/idr.s261510

Cited by 18 publications

(11 citation statements)

References 30 publications

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“…The DR-AB-infected CSF is turbid, contains floccules, and may even become purulent, blocking the drainage tube and increasing the risk of infection. The previous research of our research team showed that the extraventricular drainage tube may be more suitable for drainage of purulent cerebrospinal fluid due to its thicker tubing (24). Among the 21 patients in the present study, 1 patient had a lumber cistern drainage tube and 1 patient had a ventriculoperitoneal shunt upon admission.…”

Section: Discussionmentioning

confidence: 58%

Efficacy and safety of intraventricular polymyxin B plus continuous ventricular drainage for the treatment of intracranial infection caused by drug-resistant Acinetobacter baumannii

Chen¹,

Li²,

Li³

et al. 2022

Ann Palliat Med

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Background: The bacterial resistance rate has risen in recent years, and polymyxin B has been used more frequently to treat severe intracranial infection. This study aimed to investigate the clinical efficacy and safety profiles of intraventricular polymyxin B plus continuous ventricular drainage for the treatment of intracranial infection caused by drug-resistant Acinetobacter baumannii (DR-AB). Methods: A retrospective study was performed on 21 patients who had an intracranial infection caused by DR-AB after neurosurgery at our hospital from May 2017 to July 2020. These patients were treated by intraventricular polymyxin B plus continuous ventricular drainage. The clinical features, treatment, cerebrospinal fluid (CSF)-related indicators, outcomes, and prognosis of these patients were analyzed. Results: The external drainage tubes inserted into the lateral ventricle were kept unobstructed in all 21 patients. These patients received intraventricular polymyxin B 5 mg/day plus intravenous antibiotics. The treatment with intraventricular polymyxin B lasted for 18.19±12.36 days. The time to positive CSF culture was 10.50±10.60 days. The bacterial clearance rate of CSF was 95.2% (20/21). The clinical cure rate was 81.0% (17/21), and the mortality rate was 19.0% (4/21).As for the causes of death, 1 case died from purulent CSF with cerebral abscess, which was considered to be caused by extensive brain parenchymal infection, 2 cases died from spontaneous intraventricular hemorrhage after returning negative for CSF cultures, and 1 case died from secondary massive cerebral infarction after returning negative for CSF cultures. There were no significant changes in the serum creatinine level before and after treatment.Conclusions: For intracranial infection caused by DR-AB, early intraventricular polymyxin B plus continuous ventricular drainage could effectively clear the drug-resistant bacteria from CSF, thereby improving efficacy and reducing mortality. Renal functions before and after treatment were not changed significantly, proving that this combined treatment was safe and effective.

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Section: Discussionmentioning

confidence: 58%

Efficacy and safety of intraventricular polymyxin B plus continuous ventricular drainage for the treatment of intracranial infection caused by drug-resistant Acinetobacter baumannii

Chen¹,

Li²,

Li³

et al. 2022

Ann Palliat Med

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“…Using the definition from Kidney Disease Improving Global Outcomes (KDIGO) guidelines ( 22 ), no cases of AKI were observed in the current study. Furthermore, the incidence and severity of nephrotoxicity was reported to be rare and mild in other studies ( 7 , 16 ). This suggests the dosage of combined administration of polymyxin B in the present study was comparatively safe for renal function.…”

Section: Discussionmentioning

confidence: 77%

“…Most of the identified papers/studies were case reports, including infants and pediatric patients. Chen et al ( 16 ) reported a total of 28 patients with MDR/XDR Gram-negative bacilli intracranial infection after neurosurgery. IVT polymyxin B at a dose of 5 mg/day was used for 14.96 ± 4.28 days (range, 9–23 days) and the clinical cure rate was 82.1% (23/28).…”

Section: Discussionmentioning

confidence: 99%

Outcome of Using Intraventricular Plus Intravenous Polymyxin B in Post-neurosurgical Patients With Multi/Extensively Drug-Resistant Gram-Negative Bacteria-Induced Intracranial Infection

Wang

et al. 2022

Front. Med.

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IntroductionPost-neurosurgical central nervous system (CNS) infection caused by multidrug-resistant (MDR)/extensively drug-resistant (XDR) Gram-negative bacteria remains a major clinical challenge. This study describes our experience of treating such patients with combined intraventricular (IVT) and intravenous (IV) polymyxin B administration.MethodsThis retrospective study included six patients with post-neurosurgical CNS infections of carbapenem-resistant Acinetobacter baumannii (CRAB) or carbapenem-resistant Klebsiella pneumoniae (CRKP). All patients were treated in the intensive care unit (ICU) of First Affiliated Hospital, Zhejiang University School of Medicine (Hangzhou, China) between November 2020 and November 2021, and all received IVT plus IV polymyxin B. Data including patients' characteristics, therapeutic process, symptoms, cerebrospinal fluid (CSF) examination, laboratory tests, and complications were collected.ResultsSix patients with post-neurosurgical CNS infection were enrolled in the study. The patients comprised five males and one female, and the average age was 58 years (range, 38–73 years). Four out of the six cases were CRAB-positive in CSF culture, while two cases were CRKP-positive. The mean duration of polymyxin B administration was 14 ± 5.69 days (range, 6–20 days). The average period of patients reaching CSF sterilization was 10.33 ± 3.67 days (range, 5–14 days). All six cases were cured without acute kidney injury or epilepsy.ConclusionIVT plus IV polymyxin B is a safe and effective treatment for post-neurosurgical patients with intracranial infection caused by MDR/XDR Gram-negative bacteria.

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“…Currently, drugs with inability to adequately permeate through the BBB (including amikacin, polymyxin B) are clinically used for intrathecal therapy of CNS infections caused by MDR Gram-negative pathogens ( Tunkel et al, 2017 ; Molinaro et al, 2018 ; Nau et al, 2020 ). Intrathecal/intraventricular polymyxins combined with systemic administration were recommended to treat intracranial infection caused by CRE in recent several studies ( Chen et al, 2020 ; Zhong et al, 2020 ). However, nephrotoxicity and neurotoxicity remain major problems for the clinical use of polymyxins.…”

Section: Discussionmentioning

confidence: 99%

Successful Treatment of Severe Post-craniotomy Meningitis Caused by an Escherichia coli Sequence Type 410 Strain Coharboring blaNDM–5 and blaCTX–M–65

et al. 2021

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Intracranial infections caused by multidrug-resistant Gram-negative bacterium have led to considerable mortality due to extremely limited treatment options. Herein, we firstly reported a clinical carbapenem-resistant Escherichia coli isolate coharboring blaNDM–5 and blaCTX–M–65 from a patient with post-craniotomy meningitis. The carbapenem-resistant Escherichia coli strain CNEC001 belonging to Sequence Type 410 was only susceptible to amikacin and tigecycline, both of which have poor penetration through the blood-brain barrier (BBB). The blaCTX–M–65 gene was expressed on a 135,794 bp IncY plasmid. The blaNDM–5 gene was located on a genomic island region of an IncX3-type plasmid pNDM5-CNEC001. Based on the characteristics of the strain, we presented the successful treatment protocol of intravenous (IV) tigecycline and amikacin combined with intrathecal (ITH) amikacin in this study. Intracranial infection caused by Escherichia coli coharboring blaNDM–5 and blaCTX–M–65 is rare and fatal. Continuous surveillance and infection control measures for such strain need critical attention in clinical settings.

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<p>A Clinical Study on the Use of Intraventricular Polymyxin B Supplemented by Continuous External Ventricular Drainage in the Treatment of Drug-Resistant Gram-Negative Bacilli Intracranial Infection</p>

Cited by 18 publications

References 30 publications

Efficacy and safety of intraventricular polymyxin B plus continuous ventricular drainage for the treatment of intracranial infection caused by drug-resistant Acinetobacter baumannii

Efficacy and safety of intraventricular polymyxin B plus continuous ventricular drainage for the treatment of intracranial infection caused by drug-resistant Acinetobacter baumannii

Outcome of Using Intraventricular Plus Intravenous Polymyxin B in Post-neurosurgical Patients With Multi/Extensively Drug-Resistant Gram-Negative Bacteria-Induced Intracranial Infection

Successful Treatment of Severe Post-craniotomy Meningitis Caused by an Escherichia coli Sequence Type 410 Strain Coharboring blaNDM–5 and blaCTX–M–65

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