对于重症中枢神经系统感染的腹腔内抗生素:一个病例系列
Laura Arheilger1, Massimo Barbagallo1, Gaia Sofia Rancic1
1Neurocritical Care Unit, Institute for Intensive Care, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
Scientific reports
|November 16, 2024
概括
对于严重的中枢神经系统感染 (CNSI),静脉内抗生素治疗 (IVT) 是有效的,具有罕见的毒性. 在IVT期间脑脊液白细胞计数的快速下降预示着有利的结果.
科学领域:
- 神经学 神经学
- 传染性疾病 传染性疾病
- 药理学 药理学是指药理学的学科.
背景情况:
- 严重的中枢神经系统感染 (CNSI),包括社区获得的 CNSI (CA-CNSI) 和与医疗保健相关的腹腔炎和脑膜炎 (HAVM),与高发病率和死亡率有关.
- 腹腔内抗生素治疗 (IVT) 是一种潜在的治疗选择,但支持其有效性和安全性的证据有限.
研究的目的:
- 评估中枢神经系统严重感染 (CNSI) 患者内腔室内抗生素治疗 (IVT) 的临床结果和安全性.
- 为了比较社区获得的CNSI (CA-CNSI) 和与医疗保健相关的腹腔炎和脑膜炎 (HAVM) 之间的结果,并确定有利结果的预测因素.
主要方法:
- 对27名在10年内因严重CA-CNSI或HAVM而接受IVT的患者的数据进行了回顾性分析.
- 临床和准临床特征的评估,包括基线严重程度,功能性结果 (修改的兰金级),抗生素方案和微生物数据.
- 基于感染类型 (CA-CNSI与HAVM) 和结果 (有利与不利) 的患者组的比较.
主要成果:
- 在CA-CNSI中,阳性生物占主导地位 (64%),而在HAVM中,阴性生物更频繁 (64%).
- 患者接受了IVT的中位数为11天,罕见的相关毒性. 好的结果 (64%) 与较高的初始脑脊液白细胞计数 (CSF-WBC) 相关,该计数下降的速度更快.
- 在IVT开始后,CSF-WBC的快速下降与不论感染类型的良好结果相关.
结论:
- 腹腔内抗生素治疗 (IVT) 是重症中枢神经系统感染 (CNSI) 的安全有效选择,包括CA-CNSI和HAVM.
- 在IVT期间CSF-WBC的快速下降是有利结果的强有力的预测指标.
- 大多数幸存者实现了良好的长期功能结果,尽管最初严重的神经障碍.
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