Skip to main content

Advertisement

SpringerLink
Log in

Treatment and prognostic risk factors for intracranial infection after craniocerebral surgery

  • Research
  • Published:
Neurosurgical Review Aims and scope Submit manuscript

Abstract

The objective of this study was to determine risk factors of pejorative evolution course in patients suffering from postoperative cranial infection. The data of patients who developed an intracranial infection after craniocerebral surgery in the neurosurgical intensive care unit of the First Affiliated Hospital of Nanjing Medical University in Nanjing, Jiangsu, China, from February 2018 to August 2019 were retrospectively analyzed. Logistic regression was used to analyze the factors influencing the prognosis of intracranial infection treatment. Sixty-four patients developed an infection after craniocerebral surgery, and 48 of them with negative CSF cultures received experimental anti-infectives. In 16 patients, cerebrospinal fluid culture showed pandrug-resistant pathogens, including 11 Acinetobacter baumannii (11), Klebsiella pneumoniae (3), Escherichia coli (1), and Candida glabrata (1). Nine patients received intraventricular or intrathecal injections of polymyxin B. The mean duration of infection treatment was 22.2 ± 9.9 days, and the clinical cure rate was 85.9% (55/64). Logistic multivariate regression analysis showed that inadequate CSF drainage (OR, 6.839; 95% CI, 1.130–41.383; P = 0.036) and infection with drug-resistant bacteria (OR, 24.241; 95% CI, 2.032–289.150; P = 0.012) were independent risk factors for postoperative intracranial infection. Intracranial infection with positive CSF culture and inadequate CSF drainage are factors contributing to the poor prognosis of intracranial infection. Moreover, early anti-infection treatment and adequate CSF drainage may improve patient outcomes. In particular, intraventricular or intrathecal injection of polymyxin B may be a safe and effective treatment strategy for MDR/XDR gram-negative bacilli infection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

The data that support the findings of this study are available from the corresponding author, Dr. Jing Ji, upon request.

References

  1. Ortiz OH, García HI, Ramírez FM, Flórez JS, Valencia BA, Mantilla SE, Ochoa MJ, Ochoa JE, Jaimes F (2018) Development of a prediction rule for diagnosing postoperative meningitis: a cross-sectional study. J Neurosurg 128(1):262–271. https://doi.org/10.3171/2016.10.JNS16379

    Article  Google Scholar 

  2. De Bonis P, Lofrese G, Scoppettuolo G, Spanu T, Cultrera R, Labonia M, Cavallo MA, Mangiola A, Anile C, Pompucci A (2016) Intraventricular versus intravenous colistin for the treatment of extensively drug resistant Acinetobacter baumannii meningitis. Eur J Neurol 23(1):68–75. https://doi.org/10.1111/ene.12789

    Article  PubMed  Google Scholar 

  3. Shahan B, Choi EY, Nieves G (2021) Cerebrospinal fluid analysis. Am Fam Physician 103(7):422–428 Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/33788511

    PubMed  Google Scholar 

  4. Society, C. N., & (2017), CNCMCG Consensus of experts in the diagnosis and treatment of infection in Chinese neurosurgical critical patients (2017). Natl Med J China(21).

  5. Chen L, Li X, Li D, Dong X, Chen H (2022) Efficacy and safety of intraventricular polymyxin B plus continuous ventricular drainage for the treatment of intracranial infection caused by drug-resistant Acinetobacter baumannii. Ann Palliat Med 11(2):490–497. https://doi.org/10.21037/apm-21-3149

    Article  PubMed  Google Scholar 

  6. Tunkel, A. R., Hasbun, R., Bhimraj, A., Byers, K., Kaplan, S. L., Scheld, W. M., . . . Zunt, J. R. (2017). 2017 Infectious Diseases Society of America's Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. Clin Infect Dis, 64(6), e34-e65. https://doi.org/10.1093/cid/ciw861

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  7. Nau R, Seele J, Djukic M, Eiffert H (2018) Pharmacokinetics and pharmacodynamics of antibiotics in central nervous system infections. Curr Opin Infect Dis 31(1):57–68. https://doi.org/10.1097/QCO.0000000000000418

    Article  PubMed  CAS  Google Scholar 

  8. Kural C, Kirmizigoz S, Ezgu MC, Bedir O, Kutlay M, Izci Y (2019) Intracranial infections: lessons learned from 52 surgically treated cases. Neurosurg Focus 47(2):E10. https://doi.org/10.3171/2019.5.FOCUS19238

    Article  PubMed  Google Scholar 

  9. Zhang, Y., Cui, P., Zhang, H. C., Wu, H. L., Ye, M. Z., Zhu, Y. M., . . . Zhang, W. H. (2020). Clinical application and evaluation of metagenomic next-generation sequencing in suspected adult central nervous system infection. J Transl Med, 18(1), 199. https://doi.org/10.1186/s12967-020-02360-6

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  10. Dabrowski P, Jurkiewicz J, Czernicki Z, Koszewski W, Jasielski P (2017) Polymerase chain reaction based detection of bacterial 16S rRNA gene in the cerebrospinal fluid in the diagnosis of bacterial central nervous system infection in the course of external cerebrospinal fluid drainage. Comparison with standard diagnostics currently used in clinical practice. Neurol Neurochir Pol 51(5):388–394. https://doi.org/10.1016/j.pjnns.2017.06.013

    Article  PubMed  Google Scholar 

  11. Perdigão Neto LV, Medeiros M, Ferreira SC, Nishiya AS, de Assis DB, Boszczowski Í, Costa SF, Levin AS (2021) Polymerase chain reaction targeting 16S ribosomal RNA for the diagnosis of bacterial meningitis after neurosurgery. Clinics (Sao Paulo) 76:e2284. https://doi.org/10.6061/clinics/2021/e2284

    Article  PubMed  Google Scholar 

  12. Ruan L, Wu D, Li X, Huang Q, Lin L, Lin J, Chen L, Xu P, Jin J, Yang N, Li X (2017) Analysis of microbial community composition and diversity in postoperative intracranial infection using high-throughput sequencing. Mol Med Rep 16(4):3938–3946. https://doi.org/10.3892/mmr.2017.7082

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  13. Tattevin P, Solomon T, Brouwer MC (2019) Understanding central nervous system efficacy of antimicrobials. Intensive Care Med 45(1):93–96. https://doi.org/10.1007/s00134-018-5270-1

    Article  PubMed  Google Scholar 

  14. Li J, Zhao QH, Huang KC, Li ZQ, Zhang LY, Qin DY, Pan F, Huang WX (2017) Linezolid vs. vancomycin in treatment of methicillin-resistant staphylococcus aureus infections: a meta-analysis. Eur Rev Med Pharmacol Sci 21(17):3974–3979 https://www.ncbi.nlm.nih.gov/pubmed/28975963

    PubMed  CAS  Google Scholar 

  15. Hussein K, Bitterman R, Shofty B, Paul M, Neuberger A (2017) Management of post-neurosurgical meningitis: narrative review. Clin Microbiol Infect 23(9):621–628. https://doi.org/10.1016/j.cmi.2017.05.013

    Article  PubMed  CAS  Google Scholar 

  16. Dang S, J.-X. M., Zhou G, Wang F, Guo (2015). Etiological surveillance of intracranial infections in patients undergoing craniotomy and analysis of risk factors. Chin J Nosocomiology.

  17. Kourbeti IS, Vakis AF, Ziakas P, Karabetsos D, Potolidis E, Christou S, Samonis G (2015) Infections in patients undergoing craniotomy: risk factors associated with post-craniotomy meningitis. J Neurosurg 122(5):1113–1119. https://doi.org/10.3171/2014.8.JNS132557

    Article  PubMed  Google Scholar 

  18. Chen H, Guo X, Xie D, Dong X, Niu J, Chen G (2020) A clinical study on the use of intraventricular polymyxin B supplemented by continuous external ventricular drainage in the treatment of drug-resistant gram-negative bacilli intracranial infection. Infect Drug Resist 13:2963–2970. https://doi.org/10.2147/IDR.S261510

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  19. Abulhasan YB, Al-Jehani H, Valiquette MA, McManus A, Dolan-Cake M, Ayoub O, Angle M, Teitelbaum J (2013) Lumbar drainage for the treatment of severe bacterial meningitis. Neurocrit Care 19(2):199–205. https://doi.org/10.1007/s12028-013-9853-y

    Article  PubMed  Google Scholar 

  20. Remes F, Tomas R, Jindrak V, Vanis V, Setlik M (2013) Intraventricular and lumbar intrathecal administration of antibiotics in postneurosurgical patients with meningitis and/or ventriculitis in a serious clinical state. J Neurosurg 119(6):1596–1602. https://doi.org/10.3171/2013.6.JNS122126

    Article  PubMed  Google Scholar 

  21. Wang K, Liu Z, Chen X, Lou M, Yin J (2013) Clinical characteristics and outcomes of patients with cerebral herniation during continuous lumbar drainage. Turk Neurosurg 23(5):653–657. https://doi.org/10.5137/1019-5149.JTN.7954-13.0

    Article  PubMed  Google Scholar 

  22. Ramanan M, Lipman J, Shorr A, Shankar A (2015) A meta-analysis of ventriculostomy-associated cerebrospinal fluid infections. BMC Infect Dis 15:3. https://doi.org/10.1186/s12879-014-0712-z

    Article  PubMed  PubMed Central  Google Scholar 

  23. Governale LS, Fein N, Logsdon J, Black PM (2008) Techniques and complications of external lumbar drainage for normal pressure hydrocephalus. Neurosurgery 63(4 Suppl 2):379–384. https://doi.org/10.1227/01.NEU.0000327023.18220.88

    Article  PubMed  Google Scholar 

  24. Bari ME, Haider G, Malik K, Waqas M, Mahmood SF, Siddiqui M (2017) Outcomes of post-neurosurgical ventriculostomy-associated infections. Surg Neurol Int 8:124. https://doi.org/10.4103/sni.sni_440_16

    Article  PubMed  PubMed Central  Google Scholar 

  25. Cui Z, Wang B, Zhong Z, Sun Y, Sun Q, Yang G, Bian L (2015) Impact of antibiotic- and silver-impregnated external ventricular drains on the risk of infections: a systematic review and meta-analysis. Am J Infect Control 43(7):e23–e32. https://doi.org/10.1016/j.ajic.2015.03.015

    Article  PubMed  Google Scholar 

  26. Li, J., Fu, Y., Zhang, J., Wang, Y., Zhao, Y., Fan, X., . . . Li, C. (2019). Efficacy of tigecycline monotherapy versus combination therapy with other antimicrobials against carbapenem-resistant Acinetobacter baumannii sequence type 2 in Heilongjiang Province. Ann Palliat Med, 8(5), 651-659. https://doi.org/10.21037/apm.2019.11.06

    Article  PubMed  Google Scholar 

  27. Li Z, An Y, Li L, Yi H (2022) Intrathecal injection of tigecycline and polymyxin B in the treatment of extensively drug-resistant intracranial Acinetobacter baumannii infection: a case report and review of the literature. Infect Drug Resist 15:1411–1423. https://doi.org/10.2147/IDR.S354460

    Article  PubMed  PubMed Central  Google Scholar 

  28. Li X, Sun S, Ling X, Chen K, Wang Q, Zhao Z (2017) Plasma and cerebrospinal fluid population pharmacokinetics of vancomycin in postoperative neurosurgical patients after combined intravenous and intraventricular administration. Eur J Clin Pharmacol 73(12):1599–1607. https://doi.org/10.1007/s00228-017-2313-4

    Article  PubMed  CAS  Google Scholar 

  29. Ye J, Tan LH, Shen ZP, Yu YS, Lai DM, Fan J, Shu Q (2020) Polymyxin for the treatment of intracranial infections of extensively drug-resistant bacteria in children after neurosurgical operation. World J Pediatr 16(5):528–532. https://doi.org/10.1007/s12519-020-00350-8

    Article  PubMed  CAS  Google Scholar 

  30. McClellan N, Swanson JM, Magnotti LJ, Griffith TW, Wood GC, Croce MA, Boucher BA, Mueller EW, Fabian TC (2015) Adjunctive intraventricular antibiotic therapy for bacterial central nervous system infections in critically ill patients with traumatic brain injury. Ann Pharmacother 49(5):515–522. https://doi.org/10.1177/1060028015570466

    Article  PubMed  CAS  Google Scholar 

  31. Göçmez C, Çelik F, Tekin R, Kamaşak K, Turan Y, Palancı Y, Bozkurt F, Bozkurt M (2014) Evaluation of risk factors affecting hospital-acquired infections in the neurosurgery intensive care unit. Int J Neurosci 124(7):503–508. https://doi.org/10.3109/00207454.2013.863773

    Article  PubMed  Google Scholar 

  32. Choucha A, Boissonneau S, Beucler N, Graillon T, Ranque S, Bruder N, Fuentes S, Velly L, Dufour H (2023) Meningoencephalitis with refractory intracranial hypertension: consider decompressive craniectomy. J Neurosurg Sci 67(2):248–256. https://doi.org/10.23736/S0390-5616.21.05397-2

    Article  PubMed  Google Scholar 

  33. Hover AR, Sistrunk WW, Cavagnol RM, Scarrow A, Finley PJ, Kroencke AD, Walker JL (2014) Effectiveness and cost of failure mode and effects analysis methodology to reduce neurosurgical site infections. Am J Med Qual 29(6):517–521. https://doi.org/10.1177/1062860613505680

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors wish to thank all the patients and their families who participated in the study.

Funding

This study was funded by the National Natural Science Foundation of China (Grant No. 81972153 and 82120108018), Priority Academic Program Development of Jiangsu Higher Education Institutions (PAPD, Grant No. JX10231803), Gusu School, Nanjing Medical University (GSKY202201010), Jiangsu Province’s Key Discipline of Medicine (Grant No. XK201117), and Jiangsu Province Innovative Team (Grant No. NR17).

Author information

Authors and Affiliations

  1. Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China

    Zhen Yue, Liqing Bi, Lin Zhao & Jing Ji

  2. Department of Rehabilitation, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China

    Xiaohui Zhi

Authors
  1. Zhen Yue
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xiaohui Zhi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Liqing Bi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lin Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jing Ji
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Jing Ji: conceptualization, methodology, software. Zhen Yue: data curation, writing—original draft preparation. Liqing Bi: visualization, investigation. Xiaohui Zhi: supervision, software. Lin Zhao: validation, writing—reviewing and editing.

Corresponding author

Correspondence to Jing Ji.

Ethics declarations

Ethics approval

The research protocol was approved by our hospital ethical committee (No. 2022-NT-07).

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent to publish

The authors affirm that human research participants provided informed consent for publication.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yue, Z., Zhi, X., Bi, L. et al. Treatment and prognostic risk factors for intracranial infection after craniocerebral surgery. Neurosurg Rev 46, 199 (2023). https://doi.org/10.1007/s10143-023-02106-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s10143-023-02106-0

Keywords

Search

Navigation