Feng shang, yueqiao xu, ning wang, weitao cheng, wenjin chen, & wanru duan.Diagnosis and treatment of severe neurosurgical patients with pyogenic ventriculitis caused by gram-negative bacteria.Neurological sciences 39(2018).Doi 10.1007/s10072-017-3146-8.Abstract: the aim of the study is to explore the experiences in diagnosis and treatment of severe neurosurgical patients with pyogenic ventriculitis caused by gram-negative bacteria (g-).Nineteen patients with pyogenic ventriculitis were reviewed for their treatment.The bacterial testing results of cerebrospinal fluid (csf), the clinical intervention, and the patients¿ prognosis were evaluated.The bacterial smears of ventricular drainage from all the cases were g- bacteria.Head ct and mri scans confirmed that they were intraventricular empyema.Eighteen cases of csf bacterial test were positive, including 12 cases of acinetobacter baumannii positive, 2 of klebsiella pneumonia positive, 2 of serratia marcescens positive, 1 of pseudomonas maltophilia positive, and 1 case of escherichia coli positive.One case of the bacterial culture was negative.All patients were treated by using intraventricular lavage in combination with intravenous and intraventricular antibiotics in accordance with the clinical conditions.After treatment for 2 to 8 weeks, 14 patients were cured (74%) and 5 were died (26%).Eight patients who were cured had received ventriculoperitoneal shunt due to hydrocephalus at 2 to 6 weeks after infection controlled, and none of them had any reinfection.Twelve of the 14 cured cases came to consciousness, but 2 were persistent in vegetative state starting before the infection; they did not show any improving consciousness after infection had been cured.Suppurative ventriculitis in severe neurosurgical patients is mainly infected by g- with a higher mortality.Early diagnosis, especially in identifying pathogen types, timely ventricular irrigation, and ventricular drainage together with intravenous and intraventricular antibiotic treatment, should improve prognosis.Reported events.All patients showed the signs of neck stiffness, fever, increased respiratory rate, and sinus tachycardia to a certain extent.A (b)(6) year old male with a primary diagnosis of sah/ivh/ahp developed apv (acute pyogenic ventriculitis) after placement of the evd (external ventricular drainage).The bacteria detected was mdr-ab (multidrug-resistant acinetobacter baumannii).Antibiotics used for treatment were mp (meropenem), a/s (ampicillin-sulbactam), and mn (minocycline) for 14 days.The patient was cured and received a vps (ventriculoperitoneal shunt).A (b)(6) year old male with a primary diagnosis of avm/ahp developed apv after placement of the evd.The bacteria detected was mdr-ab.A antibiotics used for treatment were mp, a/s, and mn for 28 days.The patient was cured and received a vps.A (b)(6) year old male with a primary diagnosis of asah/ivh/ahp developed apv after placement of the evd.The bacteria detected was mdr -ab.Antibiotics used for treatment were mp, a/s, and mn for 14 days.The patient was cured and received a vps.A (b)(6) year old male with a primary diagnosis of sah/ivh/ahp developed apv after placement of the evd.The bacteria detected was serratia marcescens.Antibiotics used for treatment were mp, a/s, and mn for 7 days.The patient was cured and received a vps.A (b)(6) year old female with a primary diagnosis of svh developed apv after placement of the evd.The bacteria detected was serratia m arescens.Antibiotics used for treatment were mp, a/s, and mn for 14 days.The patient was cured.A (b)(6) year old male with a primary diagnosis of tbi/hp developed apv after placement of the evd.The bacteria detected was k.Pneumonia to p.Maltophilia, then to candida tropicalis.Antibiotics used for treatment were mp, a/s, mn, lf (levofloxacin), and sf (sulfadiazine tablet) for 56 days.The patient was cured and received a vps.A (b)(6) year old male with a primary diagnosis of asah/ivh.Ahp developed apv after placement of the evd.The bacteria detected was mdr-ab.Antibiotics used for treatment were mp, a/s, and mn for 10 days.The patient was cured.A (b)(6) year old male with a primary diagnosis of asah/ivh.Ahp developed apv after placement of the evd.The bacteria culture was negative.Antibiotics used for treatment were mp, a/s, and mn for 5 days.The patient was cured.A (b)(6) year old female with a primary diagnosis of asah/ivh.Ahp developed apv after placement of the evd.The bacteria detected was p.Maltophilia.Antibiotics used for treatment were cf (cefoperazone sodium)+s (sulbactam)+mn, and mp + mn for 25 days.The patient was cured.
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