Combined intravenous and intrathecal vancomycin in treatment of patients with intracranial infections after craniotomy / 中华危重病急救医学

ABSTRACT

Objective To explore the efficacy and safety of combined intravenous and intrathecal vancomycin in treatment of patients with intracranial infection after craniotomy. Methods Clinical data of a total of 60 consecutive patients with intracranial infections after cranial operation admitted to Department of Neurosurgery of Nanfang Hospital of Southern Medical University from June 1st 2013 to June 1st 2015 were retrospectively analyzed. The patients were divided into two groups: intravenous injection only (n = 25) and combined intravenous and intrathecal injection (n = 35). In both groups of patients intravenously given vancomycin hydrochloride 500 kU every 6 hours as well as third or fourth generation of cephalosporins or meropenem. In combined intravenous and intrathecal injection group, in addition to 20 mg vancomycin was slowly injected via lumbar puncture after release of cerebrospinal fluid (CSF) once a day. The clinical efficacy and complications of the two groups were compared. Results The recovery rate in the combined intravenous and intrathecal injection group was significantly higher than that in the intravenous injection only group (94.3% vs. 76.0%, χ2 = 4.220, P = 0.040). Lowering of white blood cell count in combined intravenous and intrathecal injection group was significantly earlier than that of the intravenous injection only group (time to become normal: 8 days vs. 13 days). The time of recovery in combined intravenous and intrathecal injection group was significantly shorter than that of the intravenous injection only group (days: 9.9±0.7 vs. 13.4±1.1, t = -2.716, P = 0.009). There were 3 patients who experienced nerve root irritation symptoms in combined intravenous and intrathecal injection group. Symptomatic treatment was given and injection speed was slowed down for these patients. There were no severe complications, such as coma, epilepsy or death in both groups. Conclusion Combined intravenous and intrathecal injection of vancomycin could be a safe and effective therapy for intracranial infection after craniotomy.