Efficacy and safety of intraventricular polymyxin B plus continuous ventricular drainage for the treatment of intracranial infection caused by drug-resistant Acinetobacter baumannii.

BACKGROUND: The bacterial resistance rate has risen in recent years, and polymyxin B has been used more frequently to treat severe intracranial infection. This study aimed to investigate the clinical efficacy and safety profiles of intraventricular polymyxin B plus continuous ventricular drainage for the treatment of intracranial infection caused by drug-resistant Acinetobacter baumannii (DR-AB). METHODS: A retrospective study was performed on 21 patients who had an intracranial infection caused by DR-AB after neurosurgery at our hospital from May 2017 to July 2020. These patients were treated by intraventricular polymyxin B plus continuous ventricular drainage. The clinical features, treatment, cerebrospinal fluid (CSF)-related indicators, outcomes, and prognosis of these patients were analyzed. RESULTS: The external drainage tubes inserted into the lateral ventricle were kept unobstructed in all 21 patients. These patients received intraventricular polymyxin B 5 mg/day plus intravenous antibiotics. The treatment with intraventricular polymyxin B lasted for 18.19±12.36 days. The time to positive CSF culture was 10.50±10.60 days. The bacterial clearance rate of CSF was 95.2% (20/21). The clinical cure rate was 81.0% (17/21), and the mortality rate was 19.0% (4/21). As for the causes of death, 1 case died from purulent CSF with cerebral abscess, which was considered to be caused by extensive brain parenchymal infection, 2 cases died from spontaneous intraventricular hemorrhage after returning negative for CSF cultures, and 1 case died from secondary massive cerebral infarction after returning negative for CSF cultures. There were no significant changes in the serum creatinine level before and after treatment. CONCLUSIONS: For intracranial infection caused by DR-AB, early intraventricular polymyxin B plus continuous ventricular drainage could effectively clear the drug-resistant bacteria from CSF, thereby improving efficacy and reducing mortality. Renal functions before and after treatment were not changed significantly, proving that this combined treatment was safe and effective.

[Establishment of artificial airway with a thermal-softened nasotracheal tube guided by fiberoptic bronchoscope].

OBJECTIVE: To assess superiority and safety of nasotracheal intubation with a thermal-softened tube guided by fiberoptic bronchoscope to establish an artificial airway for the institution of mechanical ventilation. METHODS: A total of 209 patients were randomly allocated to two groups: "treated tube" group (52 centigrade treated tube group, n=105), common tube group (the tube was prepared at room temperature 23-26 centigrade, n=104). Nasotracheal intubation was guided by a fiberoptic bronchoscope to establish an artificial airway. RESULTS: (1)The required time of the first successful nasotracheal intubation in the "treated tube" group [(14.48+/-8.31) seconds, 99 cases] was significantly shorter than in the common tube group [(23.85+/-11.97) seconds, 96 cases, P<0.01]. (2)Ratio of successful intubation in the "treated tube" group under conscious condition was higher than that of the common tube group [100% (28/28 cases) vs. 87.5% (21/24 cases), P<0.05]. (3) Ratio of successful intubation in 30 seconds in the "treated tube" group was significantly higher than that of the common tube group [93.9% (93/99 cases) vs. 68.6% (66/96 cases), P<0.01]. (4)The incidence of difficult intubation in the "treated tube" group [5.05% (5/99 cases)] was significantly lower than that of the common tube group [32.29%, (31/96 cases), P<0.01]. (5)The incidence of epistaxis in the first successful nasotracheal intubation in the "treated tube" group [4.0% (4/99 cases)] was significantly lower than that of the common tube group [15.6%,(15/96 cases), P<0.01]. (6)The incidence of epistaxis during nasotracheal intubation in conscious patients was lower in the "treated tube" (3.6%, 1/28 cases) group than that of the common tube group [28.6%, (6/21 cases), P<0.05]. CONCLUSION: The use of a thermal-softened nasotracheal tube to intubate guided by a fiberoptic bronchoscope to establish an artificial airway shortened preparation time before intubation. It is not necessary to use a vasoconstrictor for nasal mucosa before intubation, therefore cardiovascular effects due to the drugs can be avoided. It increases the willingness of conscious patients to accept the procedure and successful rate of the first intubation.