Intravenous Plus Intrathecal/intracerebral Ventricle Injection Of Polymyxinfor Post-neurosurgical Intracranial Infections Due To MDR/XDR Acinectobacter Baumannii

Background:Post-neurosurgical intracranial infections caused by multidrug-resistant or extensively drug-resistant Acinetobacter baumannii are difficult to treat and associated with high mortality.In this study,we analyzed the therapeutic efficacy of intravenous combined with intrathecal/intracerebral ventricle injection of polymyxin B for this type of intracranial infection.Methods:This retrospective study was conducted from January 2013 to September 2017 at the Second Affiliated Hospital,Zhejiang University School of Medicine(Hangzhou,China)and included 61 cases for which cerebrospinal fluid(CSF)cultures were positive for multidrug-resistant or extensively drug-resistant A.baumannii after a neurosurgical operation.Patients treated with intravenous and intrathecal/intracerebral ventricle injection of polymyxin B were assigned to the intrathecal/intracerebral group(n=23),and patients treated with other antibiotics without intrathecal/intracerebral injection were assigned to the intravenous group(n=38).Data for general information,treatment history,and the results of routine tests and biochemistry indicators in CSF,clinical efficiency,microbiological clearance rate,and the 28-day mortality were collected and analyzed.Results:The rate of multidrug-resistant or extensively drug-resistant A.baumannii infection among patients who experienced an intracranial infection after a neurosurgical operation was 33.64%in our hospital.The isolated A.baumannii were resistant to various antibiotics,and most seriously to carbapenems(100.00%resistance rate to imipenem and meropenem),cephalosporins(resistance rates of 98.38%to cefazolin,100.00%to ceftazidime,100.00%to cefatriaxone,and 98.39%to cefepime).However,the isolated A.baumannii were completely sensitive to polymyxin B(sensitivity rate of 100.00%),followed by tigecycline(60.66%)and amikacin(49.18%).No significant differences in basic clinical data were observed between the two groups.In comparison with the intravenous group,the intrathecal/intracerebral group showed a significantly decreased body temperature(39.20 ± 0.48? vs.37.48 ± 0.56?,P<0.01),a reduced number of nucleated cells in the CSF(4242.82 ± 3100.17 vs.106.45 ± 120.00 ×106/L,P<0.01),greater recovery of the glucose level in CSF(0.56 ± 1.27 mmol/L vs.3.20 ± 0.95 mmol/L,P<0.01),a decreased level of ADA in the CSF(19.18 ± 10.02 U/L vs.8.18 ±6.78 U/L,P<0.001),and reduced levels of total protein in CSF(207.10±77.40 mg/dL vs.87.81 ± 45.47 mg/dL,P=0.012).And in the same time intrathecal/intracerebral group had a significantly lower 28-day mortality(55.26%vs.8.70%,P=0.01)and higher rates of clinical efficacy and microbiological clearance(95.65%vs.23.68%,P<0.001;91.30%vs.18.42%,P<0.001,respectively).Conclusions:Intravenous plus intrathecal/intracerebral ventricle injection of polymyxin B is an effective regimen for treating intracranial infections caused by multidrug-resistant or extensively drug-resistant A.baumannii.Trial registration:No.2017-048 Date:Jul.10,2017(retrospectively registered)...