RESUMO
PURPOSE: We aimed to determine the safety and effectiveness of intraventricular antibiotics in neonates with meningitis and/or ventriculitis and analyze the quality of available evidence. METHODS: DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed, EMBASE, LILACS, and SCOPUS up to 17 February 2023. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomized experimental and observational studies were included. The Cochrane methodology was used for systematic reviews. RESULTS: Twenty-six observational studies and one randomized clinical trial involving 272 patients were included. The risk of bias in both pediatric and neurosurgical studies was high, and the quality of evidence was low (evidence level C). In the pediatric studies, no significant differences in mortality were found between intraventricular antibiotics and only systemic antibiotic [25.4% vs 16.1%, OR = 0.96 (0.42-2.24), P = 0.93]. However, when analyzing the minimum administered doses, we found a lower mortality when a minimum duration of 3 days for intraventricular antibiotics was used compared to only systemic antibiotic [4.3% vs 17%, OR = 0.22 (0.07-0.72), P = 0.01]. In the neurosurgical studies, the use of intraventricular antibiotics in ventriculitis generally results in a mortality of 5% and a morbidity of 25%, which is lower than that in cases where intraventricular antibiotics were not used, with an average mortality of 37.3% and a morbidity of 50%. CONCLUSION: Considering the low quality of evidence in pediatric and neurosurgical studies, we can conclude with a low level of certainty that intraventricular antibiotics may not significantly impact mortality in neonatal meningitis and ventriculitis. However, reduced mortality was observed in cases treated with a minimum duration of 3 days of intraventricular antibiotic, particularly the multidrug-resistant or treatment-refractory infections. Higher-quality studies are needed to improve the quality of evidence and certainty regarding the use of intraventricular antibiotics for treating neonatal meningitis and ventriculitis.
Assuntos
Ventriculite Cerebral , Meningite , Humanos , Recém-Nascido , Antibacterianos/uso terapêutico , Ventriculite Cerebral/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
BACKGROUND: This study aimed to evaluate the utility of a commercial kit used to measure serum vancomycin concentrations to determine vancomycin concentrations in cerebrospinal fluid (CSF) samples and evaluate CSF penetration when administered as a continuous high-dose infusion in patients with nosocomial ventriculitis. METHODS: This study included patients with external ventricular drain infection who were admitted to the intensive care unit between January 2018 and September 2020. After validation, CSF samples from 33 patients were collected. All patients received 30 mg/kg of vancomycin as a loading dose followed by 60 mg/kg as a maintenance dose in continuous infusion; all CSF samples were collected at least 48 hours after the first dose. RESULTS: Thirty-three patients were enrolled in this study. The median serum creatinine level was 0.66 mg/dL (0.5-0.92; n = 30), and median creatinine clearance was 119.2 mL/min (64.6-138.4; n = 13). The median serum vancomycin 24-hour area under the curve (AUC24h) was 838 mg*h/L (515-1010). The median CSF vancomycin concentration was 5.20 mg/L (1.95-12.4). Median serum vancomycin concentration was 34.9 mg/L (21.47-42.1), and median CSF/serum ratio was 18.6% (8.4-41.5). Acute renal injury occurred in 21% (n = 7) of the patients by the end of the therapy. In addition, the vancomycin CSF/serum ratio was positively correlated with the median serum creatinine level (r = 0.670; P = 0.004). CONCLUSIONS: Commercial vancomycin kits used to measure serum samples may be used to evaluate vancomycin concentrations in the CSF. Vancomycin penetration into CSF was 18.6%.
Assuntos
Ventriculite Cerebral , Infecção Hospitalar , Antibacterianos , Ventriculite Cerebral/induzido quimicamente , Ventriculite Cerebral/tratamento farmacológico , Infecção Hospitalar/induzido quimicamente , Infecção Hospitalar/tratamento farmacológico , Humanos , Unidades de Terapia Intensiva , VancomicinaRESUMO
Infections associated with neurosurgical procedures are serious complications that contribute to the morbidity and mortality of neurocritical patients, as well as to the prolongation of the stay in the ICU and the hospital. The diagnosis is complex since there is no gold standard, so it is based on clinical suspicion, CSF physical-chemical examination, and microbial isolation. Treatment should be initiated early, guided by local epidemiology. The duration will depend on the causative microorganism, its sensitivity and the availability of antibiotic treatments that are effective at the site of infection. The implementation of preventive measures with proven efficacy minimizes the risk of infection. This SADI-SATI intersociety update reviews relevant data recently published on this area at the national at international level regarding epidemiology, diagnostic methodologies, therapeutic approaches, and prevention guidelines.
Las infecciones asociadas a procedimientos neuroquirúrgicos son complicaciones graves que contribuyen a la morbimortalidad de los pacientes neurocríticos, así como también a la prolongación de la estancia en la UTI y/o en el hospital. El diagnóstico es complejo ya que no se dispone de gold standard y se apoya en la sospecha clínica, las alteraciones físico-químicas del líquido cefalorraquídeo y el aislamiento microbiano. El tratamiento debe ser precoz y guiado por la epidemiología local. La duración dependerá del microorganismo causal, su sensibilidad y la disponibilidad de tratamientos antibióticos efectivos en el sitio de la infección. La implementación de medidas de prevención con evidencia demostrada minimiza el riesgo de infección. Esta puesta al día intersociedades SADI-SATI presenta datos epidemiológicos (internacionales y locales), métodos diagnósticos, tratamiento, y pautas de prevención, considerando las publicaciones más relevantes de los últimos años sobre el tema.
Assuntos
Ventriculite Cerebral/etiologia , Meningites Bacterianas/etiologia , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/etiologia , Guias de Prática Clínica como Assunto , Antibacterianos/uso terapêutico , Ventriculite Cerebral/diagnóstico , Ventriculite Cerebral/tratamento farmacológico , Líquido Cefalorraquidiano/microbiologia , Humanos , Meningites Bacterianas/diagnóstico , Meningites Bacterianas/tratamento farmacológico , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/tratamento farmacológico , Fatores de RiscoRESUMO
Las infecciones asociadas a procedimientos neuroquiró;ºrgicos son complicaciones graves que contribuyen a la morbimortalidad de los pacientes neurocríticos, así como tambín a la prolongació;n de la estancia en la UTI y/o en el hospital. El diagnó;stico es complejo ya que no se dispone de gold standard y se apoya en la sospecha clínica, las alteraciones físico-químicas del líquido cefalorraquídeo y el aislamiento microbiano. El tratamiento debe ser precoz y guiado por la epidemiología local. La duració;n dependerá del microorganismo causal, su sensibilidad y la disponibilidad de tratamientos antibió;ticos efectivos en el sitio de la infecció;n. La implementació;n de medidas de prevenció;n con evidencia demostrada minimiza el riesgo de infecció;n. Esta puesta al día intersociedades SADI-SATI presenta datos epidemioló;gicos (internacionales y locales), mó;©todos diagnó;sticos, tratamiento, y pautas de prevenció;n, considerando las publicaciones más relevantes de los ó;ºltimos aó;±os sobre el tema.
Infections associated with neurosurgical procedures are serious complications that contribute to the morbidity and mortality of neurocritical patients, as well as to the prolongation of the stay in the ICU and the hospital. The diagnosis is complex since there is no gold standard, so it is based on clinical suspicion, CSF physical-chemical examination, and microbial isolation. Treatment should be initiated early, guided by local epidemiology. The duration will depend on the causative microorganism, its sensitivity and the availability of antibiotic treatments that are effective at the site of infection. The implementation of preventive measures with proven efficacy minimizes the risk of infection. This SADI-SATI intersociety update reviews relevant data recently published on this area at the national at international level regarding epidemiology, diagnostic methodologies, therapeutic approaches, and prevention guidelines.
Assuntos
Humanos , Complicações Pós-Operatórias/etiologia , Meningites Bacterianas/etiologia , Guias de Prática Clínica como Assunto , Procedimentos Neurocirúrgicos/efeitos adversos , Ventriculite Cerebral/etiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/tratamento farmacológico , Líquido Cefalorraquidiano/microbiologia , Fatores de Risco , Meningites Bacterianas/diagnóstico , Meningites Bacterianas/tratamento farmacológico , Ventriculite Cerebral/diagnóstico , Ventriculite Cerebral/tratamento farmacológico , Antibacterianos/uso terapêuticoRESUMO
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.