The Epidemiology,Pathogen Distribution,Diagnosis And Treatment Of Neurosurgery-Related Central Nervous System Infection

Objectives The aims of this study were 1)to describe the epidemiology,pathogen distribution and drug resistance of neurosurgery-related central nervous system（CNS）infection in a tertiary hospital.2)to investigate the diagnostic efficacy and application value of cerebrospinal fluid（CSF）metagenomic next-generation sequencing（m NGS）in the diagnosis of neurosurgery-related CNS infection.3)To investigate the clinical effect of intraventricular injection of tigecycline on severe CNS infection from multi-drug resistant gram-negative bacteria.Methods 1)A retrospective survey was conducted to obtain the clinical data of patients with CNS infection in our department from January 2017 to December 2019.Sex,age,primary disease,type of CNS infection,hospitalized ward,CSF microbial culture strains and drug sensitivity results were collected and analyzed.2)A prospective study was conducted to enroll patients with highly suspicion of CNS infection but lack of pathogen results from August 2018 to January 2020.CSF was collected to perform m NGS and microbial culture simultaneously.The sensitivity,specificity,positive predictive value,negative predictive value,Youden index and area under receiver operating characteristic（ROC）curve were calculated.3)A retrospective study was conducted to analyze the clinical data of patients with CNS infection from multi-drug resistant Gram-negative bacteria admitted to our department from November 2016to September 2018,whom received intraventricular injection of tigecycline.Body temperature,whole blood white blood cell count,CSF white blood cell count,glucose content,protein content and microbial culture results were recorded at 3d before treatment（T₁）,1d（T₂）,3d（T₃）,7d（T₄）,14d（T₅）,21d（T₆）,28d（T₇）after treatment.Creatinine,aminotransferase and nervous system symptoms were recorded at T₁ and T₆.Results 1)Among 7,768 inpatients,a total of 163 cases of CNS infection occurred[149 ventriculitis/meningitis and 14 abscess],with an incidence rate of 2.10%.Ventriculitis/meningitis and overall CNS infection had a higher incidence in intensive care units than in general wards（p<0.001）.Patients with traumatic brain injury（TBI）and CNS tumors had a higher probability of infection（p<0.001）.Thirty-five cases of positive CSF culture results were obtained,with a positive rate of 21.47%,including 16 Gram-positive bacteria,19 Gram-negative bacteria and no fungus;The proportion of drug-resistant bacteria such as methicillin-resistant Staphylococcus aureus and carbapenem-resistant gram-negative bacteria was high.2)Twenty-two patients[fifteen males and seven females,average age 50.8 years]were included and simultaneous tests were performed.During 22 test pairs,12 cases of clinical diagnosis of CNS infection were confirmed,of which 10 cases were m NGS positive and 3 cases were microbial culture positive.For m NGS,the sensitivity,specificity,positive predictive value,negative predictive value,Youden index and area under ROC curve were 83.3%,90.0%,90.9%,81.8%,0.733,0.867（p<0.001）respectively and were25.0%,90.0%,75.0%,50.0%,0.150,0.575（p=0.362）for microbial culture respectively.3)The 9 patients[eight males and one female,average age 37 years]included 7 cases of TBI,1 case of intracerebral hemorrhage and 1 case of cerebral hernia caused by cerebral infarction.Compared with T₁,body temperature and whole blood white blood cell count were decreased at T₂～T₇（p<0.05）.There was no significantly difference in CSF white blood cell count（p>0.05）.Compared with T₁,CSF glucose content was increased at T₂～T₇（p<0.05）.Compared with T₁,CSF protein content was increased at T₂～T₄,T₆ and T₇（p<0.05）.The negative rate of CSF culture was stable at 89%at T₅ and later.Before and after treatment,creatinine and aminotransferase were within the normal range,with no significantly difference（p>0.05）.Only once seizure was seen in 1case.After follow-up,1 case died with continuous positive CSF culture.In2 cases,the infection recurred and 6 cases were cured.Conclusion Neurosurgery-related CNS infection is common.Patients in intensive care units,patients with TBI and CNS tumors have a higher incidence of CNS infection.The positive rate of CSF microbial culture is low,the distribution of pathogens is mainly Gram-negative bacteria,and the drug resistance rate of most bacteria is high.m NGS has better diagnostic efficacy compared with microbial culture,revealing its value in the diagnosis of neurosurgery-related CNS infection.After intraventricular injection of tigecycline,the systemic and CSF infection indicators improved,CSF culture gradually turned negative,and adverse reactions were rare.Intraventricular injection of tigecycline has clinical value for severe CNS infection from multi-drug resistant ram-negative bacteria.