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Objective:To study the past 10 years' experiences of neonatal hydrocephalus in a single-center.Methods:From January 2010 to December 2019, clinical data of infants with hydrocephalus admitted to Neonatology Department of our hospital were retrospectively analyzed. The infants were assigned into different groups according to gestational age, different etiologies and treatments. Their clinical characteristics and outcomes were compared.Results:A total of 223 infants with hydrocephalus were included. 136 (61.0%) infants were in the preterm group and 87 (39.0%) in the full-term group. The incidence of post-intracranial hemorrhage (ICH) hydrocephalus in preterm infants was significantly higher than full-term infants ( P<0.001). According to the etiologies, 58 infants (26.0%) had congenital hydrocephalus (congenital group), 82 cases (36.8%) developed post-ICH hydrocephalus (ICH group), 48 cases (21.5%) had post-CNS-infection hydrocephalus (infection group) and 35 cases (15.7%) had post-ICH+CNS-infection hydrocephalus (ICH+infection group). The incidences of perinatal asphyxia, neonatal resuscitation and endotracheal intubation within 3 d after birth in the ICH group were significantly higher than the other groups ( P<0.05). Among the four groups, the infection group had the highest incidence of neonatal sepsis, the congenital group had the highest incidence of patent ductus arteriosus and the ICH group had the highest incidence of respiratory diseases (all P<0.05).137 cases (61.4%) received non-surgical therapy, 48 cases (21.5%) had temporary drainage, 37 cases (16.6%) with permanent shunt and 1 case (0.4%) intracranial hematoma removal. The congenital group and ICH group with permanent shunt showed significantly higher rate of improvement than temporary drainage group and non-surgical group ( P<0.001). Conclusions:The main etiologies of neonatal hydrocephalus are ICH and CNS infection. The incidence of post-ICH hydrocephalus in premature infants was quite high. Hydrocephalus of different etiologies have different comorbidities. Maternal and infant care during pregnancy and delivery, prevention of neonatal sepsis and ICH are crucial in the prevention of hydrocephalus. More studies are needed for better treatment.
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Suppurative meningoencephalitis is the kind of intracranial infectious disease which exhibits comparatively more severe clinical manifestations, more expensive diagnostic and treatment costs and poorer prognosis. Early diagnosis and effective treatment are essential for better improvement of disease prognosis. Clear identification of intrinsic and extrinsic factors causing the acute phase of suppurative meningoencephalitis, as well as its epidemiological and pathogenic characteristics, clinical manifestations and classifications, imaging features and laboratory tests explanations, may contribute greatly to the diagnostic correctness and treatment efficacy, thus promoting diagnostics and medical treatment of this disease which remains ultimately critical to patients′ prognosis.
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To investigate the risk factors for the occurrence of intracranial infection (ICI) after endoscopic transnasal resection of a pituitary adenoma and to select the best strategy for reconstructing skull base defects. Method: The clinical data of 162 patients with pituitary adenoma admitted into First Hospital of Shanxi Medical University between December 2016 and December 2019 were analyzed retrospectively. The incidence rate of ICI after surgery was analyzed. According to the occurrence of ICI, patients were stratified into ICI and non-ICI groups. The infected and non-infected groups of clinical data were collected and the independent risk factors for ICI after surgery were analyzed. Result: Among the 162 patients, 11 patients (6.79%) developed ICI, whereas 151 patients (93.21%) did not develop ICI. Body mass index (BMI), intraoperative cerebrospinal fluid leakage, postoperative cerebrospinal fluid leakage, and Kelly grades were significantly higher in the ICI group than in the non-ICI group (P<0.05). Logistic regression analysis showed that BMI, intraoperative cerebrospinal fluid leakage, postoperative cerebrospinal fluid leakage, and Kelly grades were independent risk factors for ICI after surgery (P<0.05). Conclusions: The incidence of ICI after endoscopic endonasal surgery is related to BMI, intraoperative cerebrospinal fluid leakage, postoperative cerebrospinal fluid leakage, and Kelly grades. Furthermore, reasonable strategies for skull-base reconstruction should be developed according to the Kelly grading system.
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Background: Febrile seizure is an event in infancy or childhood, usually occurring between 3 months and 5 years of age associated with fever but without evidence of intracranial infection. The aim of the study was to estimate the usefulness of neutrophil-to-lymphocyte ratio (NLR) in patients with simple and complex febrile seizures.Methods: Retrospective case control'' study was done in a paediatric in patients admitted to tertiary care hospital.' Study period'' was from January 2017 to December 2019. 200 children were analysed in the study. 100 out of 200 were under control group (febrile children without seizure). Remaining 100 were under case group (children with febrile seizure), 54 out of 100 children had'' complex febrile seizure, 46 out of 100 had simple febrile seizure. NLR ratio was done in all children.Results: Total 200 children were analysed in this study.'' High NLR ratio'' was noted among the cases (87 out of 100) compared to control (30 out of 100) p value = <0.001. Among the cases CFS had high NLR ratio compared to SFS, however p value was not significant (0.072).Conclusions: Children with febrile seizure had high NLR ratio compared to those without seizures. However no significant difference was noted between those with simple febrile seizure and complex febrile seizure'' However, larger trials are required'' to assess whether higher NLR can be taken as an independent risk factor for febrile seizure.
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Objective: To identify risk factors associated with intracranial infection after endoscopic endonasal skull base surgery. Methods: From January 2011 to December 2016, 150 patients who underwent endoscopic resection of a skull base tumor at the Chinese Academy of Medical Sciences Cancer Hospital (CAMS) were selected. Data related to general patient characteristics, underlying disease, type of operation, postoperative condition, and antimicrobial drug use, etc., were collected. The SPSS21.0 software was used to perform univariate and multivariate logistic analyses. Results: Of 150 patients, 27 had intracranial infection, and the infection rate was 18%. Logistic regression analysis revealed that no antimicrobial agents were used 0.5-1 h before the operation, external ventricular drain or lumbar drainage during operation, skull base reconstruction, and BMI ≥25 were independent risk factors for intracranial infection. Conclusions: Independent risk factors of intracranial infection after endoscopic resection of skull base tumors were screened. The results provide a basis for the accurate management of infection control at surgical sites.
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Objective To establish a two-dimensional high-performance liquid chromatography method for the determination of tigecycline in human cerebrospinal fluid, which can be used for the drug monitoring in patients with intracranial infection. Methods The quantification was carried out by an external standard method. The first-dimension column was a Aston SNX5 phenyl chromatographic column (50 mm×4.6 mm, 5 μm) with ammonium phosphate (pH was adjusted with ammonium hydroxide to 7.5)-methanol (45∶55, V/V) as the mobile phase and the flow rate was 1.2 ml/min. The second-dimension chromatographic column was Aston SC5 C18 (275 mm×4.6 mm, 5 μm), with ammonium phosphate (pH was adjusted with ammonium hydroxide to 7.4)-ammonium phosphate (pH was adjusted with ammonium hydroxide to 3.0)- acetonitrile (30∶50∶20, V/V/V) as the mobile phase and the flow rate was 1.0 ml/min. The detection wavelength was 340 nm. The temperature was 40 ℃ and the injection volume was 200 μl. Results The calibration curve of tigecycline showed good linearity from 64.5 to 1 290.0 ng/ml in human cerebrospinal fluid (r=0.999 8). The RSD of intra and inter-day precision were less than 5.0% with the detection accuracy of 98.80%−106.51%. Conclusion This method is simple, quick, accurate, specific and sensitive. It meets the requirements of tigecycline determination in clinical human cerebrospinal fluid, which offers the individualized therapeutic assurance for patients with intracranial infection.
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Objective@#To investigate the changes and clinical significance of Caveolin-1, matrix metalloproteinase-9(MMP-9) and interleukin-1β(IL-1β)in cerebrospinal fluid of children with bacterial meningitis or viral encephalitis.@*Methods@#Thirty-six cases of children with bacterial meningitis, 42 cases of children with viral encephalitis, and 20 cases of children with non-nervous system infection were selected from September 2016 to June 2018 at the Third Affiliated Hospital of Zhengzhou University.The levels of Caveolin-1, MMP-9 and IL-1β in cerebrospinal fluid were detected by using enzyme linked immunosorbent assay(ELISA).@*Results@#Cerebrospinal fluid Caveolin-1, MMP-9 , IL-1β levels in the acute phase of bacterial meningitis were(49.06±8.96) ng/L, (134.79±18.88) μg/L, (100.02±14.67) μg/L, respectively, and (29.13±7.25) ng/L, (18.69±7.23) μg/L, (47.57±8.95) μg/L in recovery phase, which were higher than those of the controls[(11.18±2.24) ng/L, (11.53±3.54) μg/L, (39.75±7.08) μg/L)], and the differences were significant (all P<0.05). Cerebrospinal fluid Caveolin-1, MMP-9, IL-1β levels in the acute phase of viral encephalitis were (42.71±10.48) ng/L, (62.78±17.39) μg/L, (57.97±11.28) μg/L, respectively, and (29.13±7.25) ng/L, (18.69±7.23) μg/L, (47.57±8.95) μg/L in recovery phase, which were higher than those of controls, and the differences were significant (all P<0.05). The levels of Caveolin-1, MMP-9 and IL-1β in cerebrospinal fluid of bacterial meningitis group and viral encephalitis group were significantly higher than those of convalescent group (all P<0.05). The levels of Caveolin-1, MMP-9, IL-1β in cerebrospinal fluid of bacterial meningitis group were significantly higher than those in viral encephalitis group (all P<0.05) in the acute phase, and no significant difference was found in the recovery phase(all P>0.05). Cerebrospinal fluid Caveolin-1, MMP-9, IL-1β showed no significant difference among children with different severity of intracranial infection.Correlation analysis showed that there was a positive correlation between Caveolin-1, MMP-9 and IL-1 β levels in cerebrospinal fluid of acute in bacterial meningitis group and viral encephalitis group(Caveolin-1 and MMP-9: R2=0.239, P<0.05; MMP-9 and IL-1β: R2=0.766, P<0.01; Caveolin-1 and IL-1β: R2=0.245, P<0.05).@*Conclusions@#Caveolin-1, MMP-9 and IL-1 β involved in the pathogenesis of intracranial infection in children, and the effects of different pathogens on intracranial infection were different.
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OBJECTIVE： To analyze effectiveness and economy of domestic vancomycin hydrochloride for injection （trade name： Laikexin） vs. imported vancomycin hydrochloride for injection （trade name： Vancocin） in treatment of intracranial infection induced by MRSA， and to provide decision-making reference for the selection of clinical drugs. METHODS： Clinical data of patients with suspected MRSA intracranial infections receiving Laikexin or Vancocin were collected by retrospective study method from neurosurgery department of our hospital during Jan. 2016 to Jun. 2017， including 115 cases of Laikexin and 42 cases of Vancocin. Using response rate （including clinical cure and clinical improvement） as indexes， cost-effectiveness analysis was performed for Laikexin and Vancocin in the treatment of intracranial infection induced by MRSA by using decision tree model. Sensitivity analysis was conducted for 10％ decrease of cost and response rate. RESULTS： Response rate and excepted cost of Laikexin were 85.21％ and 13 125.96 yuan， cost-effectiveness ratio （CER） was 15 404.25. Response rate and excepted cost of Vancocin were 78.57％ and 15 619.17 yuan， CER was 19 879.31. There was no statistical significance in response rate between Laikexin and Vancocin （P＜0.05）. There was no difference between sensitivity analysis and cost-effectiveness analysis. CONCLUSIONS： The efficacy of Laikexin and Vancocin in the treatment of MRSA intracranial infection is similar， but the CER of Laikexin is lower than that of Wenkexin.
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Objective To investigate the changes and clinical significance of Caveolin-1,matrix metalloproteinase-9 (MMP-9) and interleukin-1β (IL-1β) in cerebrospinal fluid of children with bacterial meningitis or viral encephalitis.Methods Thirty-six cases of children with bacterial meningitis,42 cases of children with viral encephalitis,and 20 cases of children with non-nervous system infection were selected from September 2016 to June 2018 at the Third Affiliated Hospital of Zhengzhou University.The levels of Caveolin-1,MMP-9 and IL-1β in cerebrospinal fluid were detected by using enzyme linked immunosorbent assay (ELISA).Results Cerebrospinal fluid Caveolin-1,MMP-9,IL-1β levels in the acute phase of bacterial meningitis were(49.06 ± 8.96) ng/L,(134.79 18.88)μg/L,(100.02 ± 14.67) μg/L,respectively,and (29.13 ± 7.25) ng/L,(18.69 ± 7.23) μg/L,(47.57 ± 8.95)pg/L in recovery phase,which were higher than those of the controls [(11.18 ± 2.24) ng/L,(11.53 ± 3.54) μg/L,(39.75 ± 7.08) μg/L)],and the differences were significant (all P ＜ 0.05).Cerebrospinal fluid Caveolin-1,MMP-9,IL-1β levels in the acute phase of viral encephalitis were (42.71 ± 10.48) ng/L,(62.78 ± 17.39) μg/L,(57.97 ± 11.28) μg/L,respectively,and (29.13 ± 7.25) ng/L,(18.69 ± 7.23) μg/L,(47.57 ± 8.95) μg/L in recovery phase,which were higher than those of controls,and the differences were significant (all P ＜ 0.05).The levels of Caveolin-1,MMP-9 and IL-1β in cerebrospinal fluid of bacterial meningitis group and viral encephalitis group were significantly higher than those of convalescent group (all P ＜ 0.05).The levels of Caveolin-1,MMP-9,IL-1β in cerebrospinal fluid of bacterial meningitis group were significantly higher than those in viral encephalitis group (all P ＜ 0.05) in the acute phase,and no significant difference was found in the recovery phase(all P ＞ 0.05).Cerebrospinal fluid Caveolin-1,MMP-9,IL-1β showed no significant difference among children with different severity of intracranial infection.Correlation analysis showed that there was a positive correlation between Caveolin-1,MMP-9 and IL-1 β levels in cerebrospinal fluid of acute in bacterial meningitis group and viral encephalitis group (Caveolin-1 and MMP-9:R2 =0.239,P ＜ 0.05;MMP-9 and IL-1β:R2 =0.766,P ＜0.01;Caveolin-1 and IL-1β:R2 =0.245,P ＜ 0.05).Conclusions Caveolin-1,MMP-9 and IL-1 β involved in the pathogenesis of intracranial infection in children,and the effects of different pathogens on intracranial infection were different.
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Non-tuberculous mycobacteria (NTM) refers to the mycobacteria other than M. tuberculosis complex and M. leprae complex, which is widely distributed in the natural environment and people can infect NTM from the environment. With the increased number of acquired immunodeficiency syndrome (AIDS) and the continuous use of immunosuppressants around the world, the number of diseases caused by NTM are also increasing continuously. However, NTM related intracranial infection is still a rare or even rare disease in clinic, which is often misdiagnosed or even missed diagnosis since the negative results of cerebrospinal fluid bacteria culture, the poor effect of anti-tuberculosis treatment and the high mortality. In present paper, we intend to summarize the documents that have been reported so far in order to review the definition of NTM, the susceptible population, classification, diagnosis and treatment of NTM related intracranial infection for further strengthening and improving awareness of such a kind of the disease.
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Objective To investigate the clinical application value of the levels of heparin-binding protein (HBP) in cerebrospinal fluid (CSF) for intracranial infectious diseases. Methods A case-control study was conducted. 150 patients after craniotomy(73 in the postoperative bacterial intracranial infection group, 77 in the postoperative non-infection group) admitted to the Department of Neurology of the People's Hospital of Liaoning Province from December 2016 to May 2018 were collected. At the same time, 46 patients without operation (14 in the non-bacterial intracranial infection group, 32 patients without intracranial infection were selected as control group whose white blood cell count (WBC) values in CSF were all below 10 × 106/L) in the same period were also collected. According to the diagnostic criteria for severe intracranial infection, the patients with bacterial intracranial infection were divided into 26 cases of mild intracranial infection group and 47 cases of severe intracranial infection group. According to the Glasgow Outcome Scale (GOS) score at the time of discharge, the patients were divided into 30 cases of good prognosis group (GOS score 4-5 points) and 43 cases of poor prognosis group (GOS score 1-3 points). The concentrations of HBP in CSF were tested with latex immunoturbidimetry, and the concentrations of procalcitonin(PCT) in cerebrospinal fluid and serum were tested with electrochemiluminescence, and cerebrospinal fluid routine were tested with instrument method, and the concentrations of total protein(TP) in cerebrospinal fluid were tested with turbidimetry. The differences of the laboratory test indicators in each group were statistically analyzed, and the levels of HBP in CSF of patients with different degrees of intracranial infection and different prognosis were compared. Comparison of two independent samples was performed using the Mann-Whitney U test. Results The HBP levels in cerebrospinal fluid were 187.00 (73.00, 635.00) ng/ml, 10.00 (3.50, 32.00) ng/ml, 1.50 (0, 4.00) ng/ml, 3.00 (1.00, 4.00) ng/ml in post-craniotomy bacterial intracranial infection group, uninfected group after craniotomy, non-bacterial intracranial infection group and control group respectively. The cerebrospinal fluid levels of WBC count were 1280.00 (363.00, 4327.00)×106/L, 63.00 (18.50, 300.00)×106/L, 5.00 (3.00, 14.75)×106/L, 3.00 (2.00, 5.75)×106/L. The absolute value of cerebrospinal fluid neutrophils were 1216.00 (225.50, 3895.50)×106/L, 24.00 (2.00, 209.50)×106/L, 1.00 (1.00, 3.00)×106/L, 1.00 (1.00, 1.00)×106/L. The cerebrospinal fluid levels of PCT were 0.16 (0.10, 0.32) ng/ml, 0.09 (0.07, 0.14) ng/ml, 0.07 (0.06, 0.12) ng/ml, 0.07 (0.06, 0.13) ng/ml. The serum levels of PCT were 0.36 (0.15, 1.09) ng/ml, 0.09 (0.04, 0.16) ng/ml, 0.08 (0.04, 0.13) ng/ml, 0.07 (0.03, 0.11) ng/ml. The levels of HBP, WBC, neutrophils, PCT in CSF and serum PCT in the post-craniotomy bacterial intracranial infection group were significantly higher than those in the uninfected group after craniotomy (Z=-9.246,-6.759,-6.741,-4.477,-6.202, P<0.05), non-bacterial intracranial infection group(Z=-5.840,-5.412,-5.259,-2.923,-5.104,P<0.05) and the control group (Z=-7.905,-7.919,-7.335,-4.397,-5.474, P<0.05). There were significant differences in the levels of HBP, WBC and neutrophils in CSF(Z=-3.763,-3.444,-3.041,P<0.05) and no significant differences in CSF and serum PCT (Z=- 0.869, - 1.850, P>0.05)between the uninfected group after craniotomy and the non-bacterial intracranial infection group. There were significant differences in the levels of HBP, WBC and neutrophils in CSF(Z=-4.496,-6.685,-4.842,P<0.05) and no significant differences in CSF and serum PCT(Z=-0.676,-1.303, P>0.05)between the uninfected group after craniotomy and the control group. There were no significant differences in the levels of HBP, PCT in CSF and serum PCT (Z=-0.861,-0.514,-0.273, P>0.05)and significant differences in the levels of WBC and neutrophils in CSF(Z=-2.756,-3.060, P<0.05) between the non-bacterial intracranial infection group and the control group. The levels of HBP in CSF in the severe intracranial infection group were significantly higher than those in the mild intracranial infection group(Z=-6.267, P<0.05). The levels of HBP in CSF in the poor prognosis group were significantly higher than those in the good prognosis group(Z=-7.064, P<0.05). The area under the ROC curve for the diagnosis of bacterial intracranial infection by HBP, WBC, neutrophils, TP, PCT in CSF and PCT in serum was 0.986, 0.987, 0.945, 0.945, 0.770 and 0.914, respectively. The area under the ROC curve for differential diagnosis of bacterial intracranial infection and non-bacterial intracranial infection was 0.994, 0.958, 0.961, 0.929, 0.747 and 0.936, respectively. Conclusions HBP in CSF is an ideal indicator for the diagnosis of bacterial intracranial infection. It is important to distinguish between bacterial intracranial infection and non-bacterial intracranial infection. The extent of increase is related to the severity of infection and prognosis of the disease.
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Objective To investigate the changes of hemorheological indexes in patients with intracranial infection after traumatic brain injury.Methods 87 cases with intracranial infection after brain trauma ,admit-ted in South Hospital of the Sixth People's Hospital Affiliated to Shanghai JiaoTong University ,from October 2016 to October 2017 ,were selected as the intracranial infection group ,and 80 cases without intracranial infec-tion after brain trauma ,admitted in the hospital from June 2015 to December 2016 ,were selected as the unin-fected group.hemorheological indexes and Glasgon Coma Scale (GCS) score were compared between the two groups.Results The high shear viscosity ,low shear viscosity ,plasma viscosity and fibrinogen(Fib) content in the intracranial infection group were higher than those in the uninfected group ,and the differences were statis-tically significant (P＜0.05) ;the GCS score of the intracranial infection group was lower than that of the un-infected group ,and the differences were statistically significant (P＜0.05) ;the high shear viscosity ,low shear viscosity ,plasma viscosity and Fib content in severe infection group were higher than those in moderate infec-tion group and mild infection group ,and the high shear viscosity ,low shear viscosity ,plasma viscosity and Fib content in moderate infection group were higher than those in mild infection group ,and the differences were statistically significant (P＜0.05) ;the GCS score of severe infection group was lower than those of moderate infection group and mild infection group ,the GCS score of moderate infection group was lower than that of mild infection group ,and the differences were statistically significant (P＜0.05).Conclusion Abnormal hem- orrheology is present in patients with intracranial infection after traumatic brain injury ,and its change is close-ly related to the severity of the disease.
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Objective To compare the differences in biochemical and routine manifestations of cerebrospinal fluid (CSF) in critically ill patients with intracranial infection caused by different pathogens in department of neurosurgery. Methods The patients with intracranial infection after neurosurgery were admitted in the department of intensive care unit (ICU) of Beijing Tiantan Hospital, Capital Medical University from January 1, 2013 to December 31, 2016, their examination results of positive CSF samples were obtained, and the differences in biochemical and routine test results among different classes of bacterial pathogens in CSF were compared. Results A total of 404 samples of 310 patients were analyzed; Gram-positive (G+) bacteria were the major cause of infection (308 case-times, 76.2%), among which, Staphylococci epidermidis was the leading causative pathogen (115 cases, 37.3%), followed by coagulase-negative Staphylococci (76 cases, 24.6%), and Staphylococcus aureus (52 cases, 16.9%); bacteria were detected in 96 case-times, accounting for 23.8% and occupying the secondary position. The overall indicator levels of CSF with G- pathogen were higher than those with G+bacteria, among which CSF with G- bacteria pathogen protein content [mg/L: 1 795 (1 999) vs. 1 068 (1 251)], white blood cell (WBC) count [×106/L: 1 069.5 (5 295.8) vs. 446.5 (1 689.3)], proportion of neutrophils [N: 0.877 (0.218) vs. 0.788 (0.416)] were obviously higher than those in CSF with G+bacteria pathogen, however, glucose (Glu) concentration level was lower than that in CSF with positive G- bacteria [mmol/L: 1.7 (2.5) vs. 2.6 (1.7), P < 0.05]. Simultaneously, it was also found that in culture G- bacteria appeared slightly later than G+bacteria [days: 9.0 (10.0) vs. 8.0 (7.0)], Acinetobacter and other negative bacteria being obvious, but as a whole there was no statistical significant difference. Conclusions G+bacteria are the major pathogens for intracranial infections patients after neurosurgery, and its time of isolation in bacterial culture has a tendency of being earlier than that of G- bacteria; in the comparisons between biochemical and routine results of CSF with positive G- bacteria and with positive G+bacteria, there are protein, glucose, WBC and N levels having statistical significant differences, suggesting that these indicators have potential values to differentiate these two kinds of bacteria.
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The whole process of consultation practice of clinical pharmacist for one case of pseudomonas aeruginosa intracranial in-fection was introduced and the role of clinical pharmacist in the anti-infective treatment was discussed. The three consultation recom-mendations of clinical pharmacist were accepted by doctors,and the patient's intracranial infection was effectively controlled and the pa-tient discharged soon. Pharmacists can help doctors develop anti-infective drug program through pharmacy thinking,horizontal thinking and risk thinking to guarantee the safety and effectiveness of patients' medication.
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OBJECTIVE:To compare the clinical efficacy,safety and economy of vancomycin and linezolid in the treatment of intracranial infections after neurosurgery operation. METHODS:Clinical data of 53 patients with intracranial infections receivingvancomycin (32 cases) and linezolid (21 cases) after neurosurgery from Jan. 2015 to Nov. 2017 were collected from medical record inquiry system of Xijing Hospital of Air Force Medical University. Pathogen detection,clinical efficacy and cerebrospinal fluid indexes were compared between 2 groups before and after treatment. The occurrence of ADR was observed in 2 groups,and treatment duration of total effective patients and total cost of antibiotics was compared. RESULTS:The bacterial culture of cerebrospinal fluid was positive in 20 patients,with positive rate of 38.46％(20/52). There was no statistical significance in pathogen positive rates and total effective rates between 2 groups (P>0.05). White blood cell count, red blood cell count, neutrophil percentage and the contents of protein in cerebrospinal fluid of 2 groups were lower than before treatment,while the contents of glucose were higher than before treatment,with statistical significance(P<0.05),besides patients with therapy failure. But there was no statistical significance in these indexes between 2 groups after treatment (P>0.05). There was no statistical significance in duration of antibiotics use and incidence of ADR between 2 groups (P>0.05). The total cost of antibiotics in vancomycin group was significantly lower than linezolid group,with statistical significance (P<0.05). CONCLUSIONS:The effectiveness and safety of vancomycin are similar to linezolid in the treatment of Gram-positive bacterial intracranial infection after neurosurgery. Vancomycin is superior to linezolid in terms of economy. If patients do not have obvious liver or kidney insufficiency,or allergies,etc.,vancomycin should still be the first choice for treatment.
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OBJECTIVE:To investigate clinical efficacy and safety of linezolid in the treatment of intracranial infection after neurosurgery operation. METHODS:Medical information of 39 intracranial infection patients receiving linezolid in Xijing Hospital of Air Force Medical University during Jul. 1st,2015-Aug. 29th,2016 were analyzed retrospectively. The clinical efficacy andsafety of linezolid in the treatment of intracranial infection after neurosurgery operation were evaluated according to indexes of intracranial infection patient,such as symptoms,signs,lab indexes test and bacterial culture results. RESULTS:Total response rate of 39 intracranial infection patients after neurosurgery operation was 79.49％ after linezolid treatment. After treatment,the patients' body temperature,white blood cell,neutrophil absolute value,white blood cell in cerebrospinal fluid and cerebrospinal fluid protein level were all significantly lower than before treatment,with statistical significance(P<0.05). Of 39 patients,cerebrospinal fluid of 27 patients were cultured before treatment,and 8 cases(29.6％)of which were positive,among which there were 6 cases (75.0％) of Gram-positive bacteria such as Staphylococcus and Enterococcus. No obvious ADR related to linezolid was found in patients. CONCLUSIONS:Linezolid can effectively control the intracranial infection caused by Gram-positive bacteria such as Staphylococcus and Enterococcus with good safety.
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Intracranial infection is a common clinical complication after craniotomy. We aimed to explore the diagnostic and prognostic value of dynamic changing procalcitonin (PCT) in early intracranial infection after craniotomy. A prospective study was performed on 93 patients suspected of intracranial infection after craniotomy. Routine peripheral venous blood was collected on the day of admission, and C reactive protein (CRP) and PCT levels were measured. Cerebrospinal fluid (CSF) was collected for routine biochemical, PCT and culture assessment. Serum and CSF analysis continued on days 1, 2, 3, 5, 7, 9, and 11. The patients were divided into intracranial infection group and non-intracranial infection group; intracranial infection group was further divided into infection controlled group and infection uncontrolled group. Thirty-five patients were confirmed with intracranial infection after craniotomy according to the diagnostic criteria. The serum and cerebrospinal fluid PCT levels in the infected group were significantly higher than the non-infected group on day 1 (P<0.05, P<0.01). The area under curve of receiver operating characteristics was 0.803 for CSF PCT in diagnosing intracranial infection. The diagnostic sensitivity and specificity of CSF PCT was superior to other indicators. The serum and CSF PCT levels have potential value in the early diagnosis of intracranial infection after craniotomy. Since CSF PCT levels have higher sensitivity and specificity, dynamic changes in this parameter could be used for early detection of intracranial infection after craniotomy, combined with other biochemical indicators.
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Humans , Male , Female , Adult , Middle Aged , Aged , Calcitonin/blood , Calcitonin/cerebrospinal fluid , Central Nervous System Bacterial Infections/diagnosis , Craniotomy/adverse effects , APACHE , Biomarkers/blood , Biomarkers/cerebrospinal fluid , C-Reactive Protein/analysis , Central Nervous System Bacterial Infections/blood , Central Nervous System Bacterial Infections/cerebrospinal fluid , Central Nervous System Bacterial Infections/microbiology , Early Diagnosis , Leukocyte Count , Postoperative Complications/blood , Postoperative Complications/cerebrospinal fluid , Postoperative Complications/microbiology , Prognosis , Prospective Studies , Reference Values , Reproducibility of Results , Risk Factors , Sensitivity and Specificity , Time FactorsABSTRACT
Objective To develop a new type of lumbar puncture needle to facilitate to measure intracranial pressure,decrease the risks for intracranial infection and brain hernia.Methods The needle was composed of a body,no.1 and no.2 sleeves,a stylet,a needle base,a catheter,joints and etc.The needle had body and stylet made of stainless steel,the catheter manufactured with medical silicone tube,the joints produced by medical rubber and the remained components by medical plastics.Results The developed needle executed pressure measuring,cerebrospinal fluid collection and medication injection with no extracting the stylet.The outflow velocity of cerebrospinal fluid was limited,and the incidences of the complications were decreased including infection,brain hernia and etc.Conclusion The lumbar puncture needle has simple structure,easy operation and high safety,and thus is worthy promoting practically.
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Objective To establish a multiplex real-time PCR mothed for rapid detection of seven species of intracranial bacteria after surgery. Methods Firstly ,the Gram′s identification was deter mined. Secondly , according to the results of Gram identification ,the bacterium was typed by the specific primers and probes to deter mine the distribution of bacteria. Simul taneously ,the sensitivity and specificity of this method were verified by making intracranial infected sim ulated samples and contrasting national standard method. Results The method established could complete detention within 4 hours with a good specificity. Staphylococcus aureus,Streptococcus pneumoniae ,Escherichia coli ,Pseudomonas aeruginosa pseudomonas ,Klebsiella pneumoniae and Acinetobacter baumannii could be detected at concentrations of ≥102 CFU/mL. Enterococcus faecalis could be detected at concen-trations of≥103 CFU/mL. The lowest detection limita of this method is higher than culture method for Streptococcus pneumoniae. Conclusions Real-time Multiplex PCR method was with high sensitivity and specificity. It reduced the detection time greatly and has great value in early diagnosis of bacteria in intracranial infection. It should be of great significance for guiding clinical treatment.
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Objective To explore the diagnostic value and clinical significance of serum procalcitonin (PCT),erythrocyte sedimentation rate(ESR),and C-reactive protein(CRP) in intracranial infection after craniocerebral surgery in patients in intensive care unit(ICU).Methods 21 patients who were admitted to the ICU in a hospital between June 2011 and January 2016 were as infection group,42 patients without intracranial infection after craniocerebral surgery during the same period were as control group.Levels of PCT,ESR,and CRP in two groups were detected and analyzed statistically.Results Differences in age,gender,average body mass index,types of craniocerebral diseases,and postoperative indwelling drainage between infection group and control group were all not statistically significant (all P＞0.05).Patients with elevated serum PCT,ESR,and CRP in infection group accounted for 95.24％,80.95％ and 90.48％ respectively,in control group were 4.76％,14.29％,and 4.76％ respectively;the average concentrations of serum PCT,ESR,and CRP between two groups were compared respectively,differences were all significant(all P＜0.05).The sensitivity of PCT,ESR,CRP,and PCT + ESR + CRP in the diagnosis of intracranial infection after craniocerebral surgery in ICU patients were 95.24％,80.95％,90.47％,and 95.61 ％respectively;specificity were 95.23％,85.71％,95.23％,and 89.37％ respectively.Conclusion The combined detection of PCT,ESR,and CRP is helpful for the diagnosis of intracranial infection after craniocerebral surgery in ICU patients,it has important guiding significance for the rational use of antimicrobial agents in early stage.