Efficacy analysis of intraventricular/intrathecal polymyxin B sulphate injections in the treatment of Post-neurosurgical CNS infections in neurocritical ill patients: a prospective observational study.

backgroundIntracranial infections due to carbapenem-resistant organisms (CRO) pose substantial challenges in the neurosurgical intensive care unit (NICU). The increasing prevalence of infections caused by carbapenem-resistant Acinetobacter (CRAB) and carbapenem-resistant Klebsiella pneumoniae (CRKP) necessitates the development of novel treatment strategies. This prospective observational study aims to evaluate the efficacy and safety of intraventricular/intrathecal polymyxin B sulfate (PBS) in NICU patients after neurosurgery.

methodsWe enrolled patients diagnosed with hospital-acquired post-neurosurgical central nervous system (CNS) infections caused by CRO at Fudan University-affiliated Huashan Hospital between January 2021 and December 2023. Detailed information on demographic characteristics, course of CRO infection treatment and follow-up data was recorded for each patient collected in this study. Upon diagnosis, all external devices were immediately removed. The treatment regimen included local intraventricular/intrathecal PBS injections, systemic antibiotics, and cerebrospinal fluid (CSF) drainage. The Fisher exact test, theχ

resultsAmong the 27 patients included in this study, 13 were infected with CRAB and 14 with CRKP, with a mean age of 49.4 ± 16.54 years. 96.3% patients had undergone surgical procedures prior to diagnosis, of which 66.7% involved combined surgeries. At the onset of infection, the mean Glasgow Coma Scale (GCS) score was 6.0 ± 2.17, the average APACHE II score was 17.3 ± 3.80, and the mean SOFA score was 5.9 ± 2.20. The total bacterial clearance rate of CSF was 81.5% (22/27), with CRAB cases achieving a clearance rate of 92.3% and CRKP cases achieving 71.4% (p = 0.163). The clinical cure rates were 69.2% (9/13) for CRAB and 64.2% (9/14) for CRKP. Importantly, the mean duration from the onset of CNS infection to the initiation of intraventricular/intrathecal injection was 4.3 ± 5.01 days, while the mean duration of treatment was 9.9 ± 3.92 days. The time to achieve negative CSF cultures averaged 10.6 ± 7.02 days. No significant differences were found between the CRAB and CRKP groups, except for variations in sex ratio.

conclusionThe findings of our study verified the efficacy and safety of intraventricular/intrathecal PBS in treating CRO-related intracranial infections in neurosurgical patients. The combination of local PBS administration and systemic antibiotic therapy offers a more efficient treatment approach for these complex infections.