A Retrospective Study On The Diagnosis And Treatment Of Central Nervous System Infections After Neurosurgery In Peking Union Medical College Hospital

Background:Postoperative central nervous system infections(PCNSIs)are serious complication and the timely use of antibiotics guided by causative pathogens and sensitivities is the essential for the treatment.However,there is few data about the prevalence of pathogens in China.The aim of this study is to investigate the feature of pathogens in patients with PCNSIs,which could help the clinician to choose the appropriate empirical antibiotic therapy.Methods:we retrospectively examined the CSF-positive culture in patients underwent craniotomy between January 2010 and December 2015.We collected the data including demographic characteristics,types of neurosurgery,laboratory data,causative organisms and antimicrobial susceptibility testing.Results:62 patients with 90 isolates from 818 patients with 2433 CSF culture samples were available for data analysis.The estimated incidence and culture-positive rate of PCNSIs were about 0.9%and 7.5%,respectively.The predominant organism was coagulase-negative staphylococci,which most of them were methicillin-resistant coagulase-negative staphylococci(MRCoNS)and all susceptible to Vancomycin,linezolid,rifampicin and Amoxicillin-Clavulanate.Acinetobacter baumannii was the most frequent causative Gram-negative agent and was most extensively drug-resistant(XDR)or pandrug-resistant(PDR).The sensitivity rates of tigecycline and minocycline were only 44%and 33%,respectively.Conclusion:PCNSIs can lead to high mortality.Although the MRCoNS were the predominant organism,the management of Acinetobacter baumannii was a major clinical challenge with increasing rapidly and few effective antimicrobials.Background:Postoperative central nervous system infections(PCNSIs)caused by extensively drug-resistant(XDR)or pandrug-resistant(PDR)Acinetobacter baumannii are rare but intractable problems.To investigate a potential combined strategy to treat AB organisms that are resistant to not only meropenem but also colistin.Methods:We retrospectively reviewed cerebrospinal fluid positive culture isolates of AB in patients who underwent neurosurgery.Medical records were collected by standard forms and analyzed.16 patients met the criteria and most patients were middle-aged men who had undergone craniotomy or endonasal transsphenoidal surgery.68.8%AB isolates were XDR bacteria,and 18.8%isolates were PDR bacteria.12 patients were treated by meropenem-based regimen strategy.Another 4 patients were administered tetracycline-based regimens.93.8%patients were treated with therapeutic drainage,and strict hygiene rules were followed.Finally,12 patients survived their infections,and the average Glasgow Outcome Scale score was 2.9±1.4 at discharge.And the mortality rates of carbapenem-resistant AB(CRAB)were 8.3%.Conclusion:PCNSIs caused by XDR/PDR AB are a rare and serious complication.Combined therapy based on the individual situation,including appropriate antimicrobial agents,surgical management and strict hygiene management,might be an effective therapeutic strategy...