RESUMO
Ventriculitis after extraventricular drainage is a very important neurosurgical complication in neurocritical care units. It is necessary to make an early diagnosis, given that the morbidity and mortality secondary to it can be variable, and complicate the evolution of neurocritical patients. Despite this, ventriculostomy continues to be an important pillar in monitoring and treatment. Given the urgency of ventriculitis associated with multiresistant germs, new antimicrobial drugs have emerged as part of the treatment, as intraventricular routes have been proposed within the new investigations. However, the foregoing does not yet have sufficient bases to be able to support it. The present review was carried out with the aim of contributing to an early diagnosis and treatment of ventriculitis associated with extra ventricular drainage in neurocritical patients, and in this way to contribute to improve survival and prevent fatal outcomes in these patients.
La ventriculitis posterior a un drenaje extraventicular constituye una complicación neuroquirúrgica muy importante en las unidades de cuidados neurocríticos. Se hace necesario realizar un diagnóstico precoz, dado que la morbimortalidad secundaria a esta puede ser variable y complicar la evolución de los pacientes neurocríticos. A pesar de esto, la ventriculostomía continúa siendo un pilar importante en el monitoreo y el tratamiento. Ante la urgencia de ventriculitis asociadas a gérmenes multirresistentes han surgido nuevos fármacos antimicrobianos como parte del tratamiento, al igual que se han propuesto vías intraventriculares dentro de las nuevas investigaciones. Sin embargo, lo anterior aún no tiene bases suficientes para poder sustentarlo. La presente revisión se realizó con el objetivo de contribuir a un diagnóstico precoz y al tratamiento de la ventriculitis asociada a drenaje extraventricular en pacientes neurocríticos, y de esta forma poder mejorar la sobrevida y prevenir desenlaces fatales en estos pacientes.
Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas do Sistema Nervoso Central , Ventriculite Cerebral , Drenagem/efeitos adversos , Ventriculostomia/efeitos adversos , Infecções Bacterianas do Sistema Nervoso Central/diagnóstico , Infecções Bacterianas do Sistema Nervoso Central/tratamento farmacológico , Ventriculite Cerebral/líquido cefalorraquidiano , Ventriculite Cerebral/diagnóstico , Ventriculite Cerebral/microbiologia , Ventriculite Cerebral/terapia , Estado Terminal , Drenagem/métodos , Diagnóstico Precoce , Humanos , Unidades de Terapia Intensiva , Infecções Relacionadas à Prótese/líquido cefalorraquidiano , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/microbiologiaRESUMO
Use of Intrathecal colistin has increased in recent years and has become an alternative for the management of infections of the central nervous system caused by multidrug resistant (MDR) bacteria. Evidence of therapeutic success and safety profile is increasing, particularly in MDR Acinetobacter baumanii infections in adults. Conversely, evidence in children is limited. We present a case of an 11-year-old female with postsurgical meningitis caused by an extensively resistant Pseudomonas aeruginosa strain and treated with venous and intrathecal colistin. The evidence of its use in children with nosocomial meningitis by MDR Gram negative bacteria is reviewed.
Assuntos
Antibacterianos/administração & dosagem , Ventriculite Cerebral/tratamento farmacológico , Colistina/administração & dosagem , Infecções por Pseudomonas/tratamento farmacológico , Neoplasias Encefálicas/cirurgia , Ventriculite Cerebral/microbiologia , Criança , Feminino , Humanos , Injeções Espinhais , Complicações Pós-Operatórias , Pseudomonas aeruginosa/isolamento & purificaçãoRESUMO
Infections caused by rare micro-organisms are the subject of research, as researchers are encouraged to find the necessary health measures to prevent and treat the disease, as well as the search for new insights into human-microbial interactions. This report describes the case of a newborn boy diagnosed with hydrocephalus and myelomeningocele who developed ventriculitis and sepsis from resistant Empedobacter brevis. This case highlights the unexpected identification of this bacterium in the cerebrospinal fluid and its multi-resistant pattern, which was crucial for proper therapeutic management. This bacterium shows a mixture of different etiologies in the analysis of cerebrospinal fluid.
Las infecciones causadas por microorganismos poco comunes son objeto de investigación, ya que animar a los investigadores a encontrar las medidas sanitarias necesarias para prevenir y tratar la enfermedad, así como la búsqueda de nuevas luces sobre las interacciones humano-microbios. En este informe se describe el caso de un recién nacido varón diagnosticado de hidrocefalia y mielomeningocele, que desarrolló ventriculitis y sepsis por Empedobacter brevis resistente. Este caso pone de manifiesto la inesperada identificación de esta bacteria en el líquido cefalorraquídeo y su patrón multirresistente, que fue crucial para dar un manejo terapéutico adecuado. Esta bacteria evidencia una mezcla de diferentes etiologías en el análisis del líquido cefalorraquídeo.
Assuntos
Ventriculite Cerebral/microbiologia , Infecções por Flavobacteriaceae , Flavobacterium , Ventriculite Cerebral/diagnóstico , Ventriculite Cerebral/tratamento farmacológico , Infecções por Flavobacteriaceae/diagnóstico , Infecções por Flavobacteriaceae/tratamento farmacológico , Humanos , Recém-Nascido , Masculino , PeruRESUMO
PURPOSE: A patient with carbapenem-resistant Klebsiella pneumoniae infection is described, and treatment options are discussed. SUMMARY: Few antibiotics to treat carbapenem-resistant Enterobacteriaceae (CRE) infection are available, and treatment is further complicated by the limited ability of many antibiotics to penetrate into the cerebrospinal fluid (CSF). Currently, there is a lack of clinical data on the treatment of central nervous system CRE infections, and therapy is based on case reports, case series, and small retrospective studies. A patient was admitted to the emergency department with intracranial hemorrhage and ventriculitis due to traumatic injury. A ventriculostomy and, subsequently, a ventriculoperitoneal (VP) shunt were placed. After approximately a month of treatment with various antibiotic regimens, the patient's VP shunt was externalized, and a CSF culture speciated carbapenem-resistant K. pneumoniae and Pseudomonas aeruginosa. The patient was then switched to i.v. ceftazidime-avibactam and intrathecal amikacin therapy. His CSF cultures were sterile 3 days after initiation of those antibiotics, and subsequent CSF cultures resulted in no growth. After the patient was treated with intrathecal amikacin 30 mg daily for 4 weeks and i.v. ceftazidime-avibactam 2.5 g every 8 hours for 6 weeks, the ventriculitis resolved, the external ventricular drain was removed, and he was transferred to a long-term care facility for rehabilitation. CONCLUSION: A man with ventriculitis caused by P. aeruginosa and carbapenem-resistant K. pneumoniae was successfully treated with i.v. ceftazidime-avibactam and intrathecal amikacin.
Assuntos
Amicacina/uso terapêutico , Antibacterianos/uso terapêutico , Compostos Azabicíclicos/uso terapêutico , Ceftazidima/uso terapêutico , Ventriculite Cerebral/tratamento farmacológico , Infecções por Klebsiella/tratamento farmacológico , Klebsiella pneumoniae , Infecções por Pseudomonas/tratamento farmacológico , Pseudomonas aeruginosa , Adulto , Amicacina/administração & dosagem , Antibacterianos/administração & dosagem , Compostos Azabicíclicos/administração & dosagem , Enterobacteriáceas Resistentes a Carbapenêmicos , Ceftazidima/administração & dosagem , Ventriculite Cerebral/microbiologia , Ventriculite Cerebral/cirurgia , Combinação de Medicamentos , Quimioterapia Combinada , Humanos , Injeções Intravenosas , Injeções Espinhais , Infecções por Klebsiella/complicações , Infecções por Klebsiella/microbiologia , Masculino , Infecções por Pseudomonas/complicações , Infecções por Pseudomonas/microbiologia , Derivação Ventriculoperitoneal , VentriculostomiaRESUMO
RESUMEN Las infecciones causadas por microorganismos poco comunes son objeto de investigación, ya que animar a los investigadores a encontrar las medidas sanitarias necesarias para prevenir y tratar la enfermedad, así como la búsqueda de nuevas luces sobre las interacciones humano-microbios. En este informe se describe el caso de un recién nacido varón diagnosticado de hidrocefalia y mielomeningocele, que desarrolló ventriculitis y sepsis por Empedobacter brevis resistente. Este caso pone de manifiesto la inesperada identificación de esta bacteria en el líquido cefalorraquídeo y su patrón multirresistente, que fue crucial para dar un manejo terapéutico adecuado. Esta bacteria evidencia una mezcla de diferentes etiologías en el análisis del líquido cefalorraquídeo.
ABSTRACT Infections caused by rare micro-organisms are the subject of research, as researchers are encouraged to find the necessary health measures to prevent and treat the disease, as well as the search for new insights into human-microbial interactions. This report describes the case of a newborn boy diagnosed with hydrocephalus and myelomeningocele who developed ventriculitis and sepsis from resistant Empedobacter brevis. This case highlights the unexpected identification of this bacterium in the cerebrospinal fluid and its multi-resistant pattern, which was crucial for proper therapeutic management. This bacterium shows a mixture of different etiologies in the analysis of cerebrospinal fluid.
Assuntos
Humanos , Recém-Nascido , Masculino , Flavobacterium , Infecções por Flavobacteriaceae , Ventriculite Cerebral/microbiologia , Peru , Infecções por Flavobacteriaceae/diagnóstico , Infecções por Flavobacteriaceae/tratamento farmacológico , Ventriculite Cerebral/diagnóstico , Ventriculite Cerebral/tratamento farmacológicoRESUMO
Resumen El uso de colistina por vía intratecal se ha consolidado como una opción terapéutica para el manejo de infecciones del sistema nervioso central causadas por bacilos gramnegativos multi-resistentes. La evidencia del éxito terapéutico y del perfil de seguridad es creciente, particularmente en infecciones por Acinetobacter baumanii multi-resistente en adultos. La evidencia en niños es escasa. Se presenta el caso clínico de una niña de 11 años de edad, con una ventriculitis post-quirúrgica por Pseudomonas aeruginosa extensamente resistente tratada con colistina intravenosa e intratecal. Se revisa su uso en niños con meningitis nosocomial causada por bacilos gramnegativos multi-resistentes.
Use of Intrathecal colistin has increased in recent years and has become an alternative for the management of infections of the central nervous system caused by multidrug resistant (MDR) bacteria. Evidence of therapeutic success and safety profile is increasing, particularly in MDR Acinetobacter baumanii infections in adults. Conversely, evidence in children is limited. We present a case of an 11-year-old female with postsurgical meningitis caused by an extensively resistant Pseudomonas aeruginosa strain and treated with venous and intrathecal colistin. The evidence of its use in children with nosocomial meningitis by MDR Gram negative bacteria is reviewed.
Assuntos
Humanos , Feminino , Criança , Infecções por Pseudomonas/tratamento farmacológico , Colistina/administração & dosagem , Ventriculite Cerebral/tratamento farmacológico , Antibacterianos/administração & dosagem , Complicações Pós-Operatórias , Pseudomonas aeruginosa/isolamento & purificação , Injeções Espinhais , Neoplasias Encefálicas/cirurgia , Ventriculite Cerebral/microbiologiaRESUMO
BACKGROUND: Studies on the implantation of care routines showed reduction on EVD catheter-related infections rates; however zero tolerance is difficult to be achieved. The objective of this study was to assess the impact of an educational intervention on the maximal reduction on rates of EVD-related infections. METHODOLOGY/PRINCIPAL FINDINGS: The quasi-experimental (before-after intervention) study occurred in two phases: pre-intervention, from April 2007 to July 2008, and intervention, from August 2008 to July 2010. Patients were followed for 30 days after the removal of the EVD, and EVD-related infections were considered as only those with laboratorial confirmation in the CSF. Observations were made of the care of the EVD and compliance with Hygiene of the Hands (HH), a routine of care was drawn up, training was given, and intervention was made to reduce the time the EVD catheter remained in place. RESULTS: during the study, 178 patients were submitted to 194 procedures, corresponding to 1217 EVD catheters-day. Gram-negative agents were identified in 71.4% of the infections during the pre-intervention period and in 60% during the intervention period. During the study, EVD-related infection rates were reduced from 9.5% to 4.8% per patient, from 8.8% to 4.4% per procedure, and the incidence density dropped from 14.0 to 6.9 infections per 1000 catheters-day (p = 0.027). The mortality reduced 12% (from 42% to 30%). CONCLUSIONS/SIGNIFICANCE: During one year after the fourth intervention, no microbiologically identified infection was documented. In light of these results, educational intervention proved to be a useful tool in reducing these rates and showed also impact on mortality.