Polymyxin for the treatment of intracranial infections of extensively drug-resistant bacteria in children after neurosur
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BRIEF REPORT
Polymyxin for the treatment of intracranial infections of extensively drug‑resistant bacteria in children after neurosurgical operation Jing Ye1 · Lin‑Hua Tan1 · Zhi‑Peng Shen2 · Yun‑Song Yu3 · Deng‑Ming Lai4 · Jie Fan5,6,7 · Qiang Shu8 Received: 16 January 2020 / Accepted: 25 February 2020 © Children’s Hospital, Zhejiang University School of Medicine 2020
Abstract Background Increased meningitis caused by extensively drug-resistant bacillary presents a significant challenge in antibiotic selection. The aim of our study was to evaluate the efficacy and safety of polymyxin in the treatment of post-neurosurgical meningitis due to the extensively drug-resistant bacillary in children. Methods We performed a retrospective study on post-neurosurgical meningitis caused by the extensively drug-resistant bacillary in children, who were treated with polymyxin for ≥ 3 days. Results Among five post-neurosurgical meningitis cases that were included, the children were infected by Acinetobacter baumannii (n = 3), Klebsiella pneumonia (n = 1), and Pseudomonas aeruginosa (n = 1). The drug susceptibility test showed that they were extensively drug-resistant bacillary. Two patients received intravenous polymyxin E. Three children received intravenous combined with intraventricular injection of polymyxin B. One patient infected by Klebsiella pneumonia eventually died of septic shock. No serious adverse effects of polymyxin were observed. Conclusions Polymyxin is a safe and effective therapy for post-neurosurgical, multidrug-resistant bacillary meningitis in children. Keywords Drug resistance · Meningitis · Neurosurgical procedures · Polymyxin
Introduction Post-neurosurgical meningitis is a common complication, accounting for 0.8–7% of intracranial infections [1]. Meningitis caused by multidrug-resistant (MDR) or extensively drug-resistant (XDR) Gram-negative bacillary meningitis (GNBM) lead to a significant limitation in currently available treatment options. Due to the abuse of broad-spectrum
antibiotics, the prevalence of meningitis with MDR/ XDR bacillary remains high. The percentage of meningitis following neurosurgery caused by Acinetobacter baumannii ranged from 15–21.74% [2],and the associated mortality rate was between 20 and 40% [3]. Due to increased resistance of MDR/XDR bacterial and lack of new antibiotics, the utilization of polymyxin have shown promising results [4]. The treatment strategies for XDR meningitis especially
* Qiang Shu [email protected] 1
2
Department of Surgical ICU, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou 310052, China Department of Neurosurgery, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou 310052, China
3
Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
4
Department of Neonatal Surgery, Children’s Hospital, Zhejiang University School of
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