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[Two cases of methicillin-resistant Staphylococcus aureus (MRSA) sepsis following craniotomy]
Abstract:
We report here two cases of MRSA sepsis following craniotomy. In case 1, a petroclival meningioma was subtotally removed and lumbar drainage was inserted postoperatively to prevent cerebrospinal fluid leakage. Ventriculo-peritoneal shunt was performed after meningitis was treated with vancomycin and panipenem/betamipron. Two weeks after the procedure, the patient revealed continuous spiking fevers related to MRSA sepsis, which did not improve with vancomycin and arbekacin administration. The focus of infection was found by scintigraphy and CT by 67Ga to be spondylo-diskitis at the level of L2-L3. The lesion was removed and bone from the iliac crest grafted. In case 2, seven days after surgery for multiple meningioma, the patient exhibited spiking fevers and swelling in the left leg. The central venous catheter was removed from the left femoral vein and MRSA was found from blood culture. The patient was treated with arbekacin (200 mg/day). Venous thrombosis diagnosed by CT was treated with heparin. Symptoms related to the infection and laboratory data did not improve because the concentration of arbekacin in the blood did not reach an effective level. The symptoms markedly improved when the dose of arbekacin was doubled (400 mg/day).
Insights
Two cases of Methicillin-resistant Staphylococcus aureus (MRSA) sepsis after craniotomy highlight diagnostic challenges. Effective treatment required identifying the infection source and optimizing antibiotic dosing, particularly for MRSA sepsis.
Area of Science:
- Neurosurgery
- Infectious Diseases
- Medical Microbiology
Background:
- Craniotomy is a neurosurgical procedure that carries a risk of post-operative infections.
- Methicillin-resistant Staphylococcus aureus (MRSA) is a significant pathogen in healthcare-associated infections.
- Sepsis following neurosurgery can present with diverse and sometimes delayed symptoms.
Observation:
- Case 1: A patient developed MRSA sepsis with spondylodiskitis (L2-L3) post-craniotomy for petroclival meningioma, initially unresponsive to standard antibiotics.
- Case 2: Another patient presented with MRSA sepsis and deep vein thrombosis after meningioma surgery, with suboptimal response to initial antibiotic therapy.
- Diagnostic imaging, including 67Ga scintigraphy and CT, was crucial in identifying the deep-seated infection focus in Case 1.
Findings:
- MRSA sepsis can manifest as deep-seated infections, such as spondylodiskitis, following neurosurgical procedures.
- Inadequate antibiotic concentrations, as seen with arbekacin in Case 2, can lead to treatment failure.
- Optimizing antibiotic dosage based on therapeutic drug monitoring is essential for effective management of MRSA sepsis.
Implications:
- Early and accurate diagnosis of MRSA sepsis post-craniotomy is critical for successful patient outcomes.
- Multidisciplinary management involving neurosurgery, infectious diseases, and radiology is often required.
- This report underscores the importance of considering atypical presentations and optimizing antimicrobial therapy in neurosurgical patients with suspected sepsis.