Infection and Drug Resistance (Aug 2020)
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
Abstract
Hongwei Chen,1 Xiaochuan Guo,1 Dongcheng Xie,1 Xuanwei Dong,1 Jianxing Niu,1 Guoqiang Chen2 1Department of Neurosurgery for Cerebrospinal Fluid Diseases, Aviation General Hospital of China Medical University, Beijing 100012, People’s Republic of China; 2Department of Neurosurgery, Aviation General Hospital of China Medical University, Beijing 100012, People’s Republic of ChinaCorrespondence: Guoqiang ChenDepartment of Neurosurgery, Aviation General Hospital of China Medical University, No. 3 Anwai Beiyuan Street, Chaoyang District, Beijing 100012, People’s Republic of ChinaTel/ Fax +86-010 59520008Email [email protected]: To investigate the clinical effect of ventricular polymyxin B supplemented by continuous external ventricular drainage in the treatment of intracranial infection with multidrug-resistant (MDR) or extensively drug-resistant (XDR) Gram-negative (G-) bacilli following neurosurgery.Patients and Methods: A retrospective analysis was performed on 28 patients who had G-bacilli intracranial infection following neurosurgery in our department between January 2017 and December 2019. The patients were treated with intraventricular polymyxin B supplemented by continuous external ventricular drainage. The clinical characteristics, treatment process, cerebrospinal-fluid-related indicators, results and prognosis were analysed.Results: All of 28 patients developed an infection subsequent to neurosurgery, and cerebrospinal fluid (CSF) cultures demonstrated MDR/XDR G- bacilli, including Acinetobacter baumannii in 14 cases, Klebsiella pneumoniae in 9 cases, Pseudomonas aeruginosa in 3 cases, and Enterobacter cloacae in 2 cases. The ventricular drainage tube remained unobstructed in all patients during treatment, and intraventricular polymyxin B combined with intravenous antibiotics were administered each day. The duration of treatment with intraventricular polymyxin B was 14.96± 4.28 days, and the time required to obtain a negative CSF culture was 8.23± 4.02 days. The bacterial clearance rate from cerebrospinal fluid was 92.9% (26/28), and the clinical cure rate was 82.1% (23/28). Among them, 18 patients underwent ventriculoperitoneal shunt insertion for hydrocephalus 82.5 (59.5,114.75) days after the infection was cured, and the mortality rate was 17.6% (5/28). There was no significant change in patient blood creatinine levels before and after treatment. Cured patients were followed up for 4 months to 3 years, and no recurrences were observed.Conclusion: Treatment of intracranial infection with MDR/XDR G- bacilli using early intraventricular polymyxin B supplemented by continuous external ventricular drainage treatment may be a safe and effective treatment strategy.Keywords: intracranial infection, drug-resistant, Gram-negative(G-)bacilli, intraventricular polymyxin B, continuous external ventricular drainage
