Research Of The Blood And CSF Concentration Of Meropenem In Patients With Intracranial Infection After Neurosurgery And Pathogenic Characteristics Analysis

Objective1. Postoperative intracranial infection is a common complication in neurosurgery. Meropenem is a commonly used antibiotics to treat postoperative intracranial infection. There have been pharmacokinetics studies and recommended doses on meropenem in foreign countries, but there was no domestic related research. In this study we measured the drug concentration of meropenem in the blood and CSF in patients with intracranial infection after neurosurgery, and proposed some suggestion for clinical use of meropenem.2. Search the relevant history information, and analyzethe the pathogen distribution of infection case of Neurosurgery, Huashan Hospital in 2005-2009.Methods1. In this study we selected 82 intracranial infection cases after neurosurgical operation. According to the patients' conditions, we use different doses of meropenem, and divided the cases into 3 groups:1g, q8h; 1g, q6h; 2g, q8h. We collect the blood and CSF specimens when using meropenem at the first time on the third day, Randomize to 2 groups:I group, the collective moment is "in instillation, 10min, 2hr and 4hr after instillation.â…¡group:the collective moment is "instantly after instillation, lhr,3hr after instillation and instantly before next instillation. The specimens were measured by the method of High performance Liquid Chromatography (HPLC) to obtain concentration of meropenem in blood and CSF. Then we collect the clinical information and data, enter them to the excel table to establish a database, then establish the concentration-time curve, using PSPP18 to perform the statistical analysis, considered significant difference when P<0.05.2. Search the positive result of CSF culture in Antibiotics Research Institute of Huashan Hospital in 2005-2009, and review the relevant history information.ResultsThere were no statistical differences about the age, height, weight among three groups(P<0.05).There were no obvious differences about the blood concentration of meropenem among three groups, but there were obvious differences about the CSF concentration. The CSF concentration of meropenem in 1g,q8h group and 1g,q6h group changed smoothly over time, and the CSF concentration of 1g,q8h group was lower than 1g,q6h group. The CSF concentration-time curve of 2g,q8h was wavy obviously, and wave around the curve of 1g,q6h group. After instillation of meropenem, the CSF/ blood concentration ratios of meropenem had gradually increased with time. The 1g, q8h group largest ratio was 161%, the 1g, q6h group largest ratio is 219%, the 2g, q8h group largest ratio 245%. It could be seen that there was no obvious difference about the ratio between 1g, q6h group and 2g, q8h group and both them were significantly higher than the 1g, q8h group largest ratio. The blood-brain barrier penetration of meropenem increased with the daily dose.Conclusions1. Meropenem has the great advantage in the treatment of intracranial Gram-negative bacterial infection after neurosurgery. In order to achieve the MIC90 of most bacteria and reduce the side effect, we tend to use meropenem with 1g,q6h intravenous dripping.2. The major bacterial of intracranial infection after neurosurgery were gram-negative bacillus in Huashan Hospital since 2008. The amount of bacterial strain was largest in 2006 and smaller than before from 2007-2009. According to the characteristic of meropenem, meropenem still apply to the case of intracranial infection after neurosurgery in Huashan Hospital.