scholarly journals Intracranial Infection Caused by Multidrug-resistant Acinetobacter Baumannii

2021 ◽  
Vol 18 (4) ◽  
pp. 59-63
Author(s):  
Haiyong He ◽  
Manting Li ◽  
Ying Guo ◽  
Lun Luo ◽  
Robin Bhattarai ◽  
...  
Keyword(s):  
Acinetobacter Baumannii ◽  
Fourth Ventricle ◽  
Relevant Literature ◽  
Clinical Manifestations ◽  
Multidrug Resistant ◽  
External Ventricular Drainage ◽  
Ventricular Drainage ◽  
Intracranial Infection ◽  
Intracranial Infections

Objective: To report the successful treatment of a patient who underwent vestibular schwannoma resection and developed intracranial infection caused by multidrug-resistant Acinetobacter baumannii (MRAB), and to review the recent relevant literature. Methods: The patient was diagnosed with MRAB infection based on clinical manifestations and cerebrospinal fluid (CSF) culture. The treatment included external ventricular drainage, posterior fossa decompressive craniectomy, and endoscopic lavage for fourth ventricle, subdural drainage, and intravenous injection /ventricular irrigation of sulperazone. Results: The MRAB-induced intracranial infection was successfully cured. The follow-up lasted for 84 months, and the patient has resumed normal life and work. Conclusion: Active individualized treatment should be administered at the earliest. The drainage of CSF, ventricular lavage, and proper choice of antibiotics are key to treat intracranial infections caused by MRAB.

A nationwide prospective multicenter study of external ventricular drainage: accuracy, safety, and related complications

2021 ◽  
pp. 1-9
Author(s):  
Ayoub Dakson ◽  
Michelle Kameda-Smith ◽  
Michael D. Staudt ◽  
Pascal Lavergne ◽  
Serge Makarenko ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Clinical Manifestations ◽  
External Ventricular Drainage ◽  
Infectious Complications ◽  
Ventricular Drainage ◽  
Midline Shift ◽  
Operator Experience ◽  
Vein Thrombosis ◽  
Preoperative Antibiotic Prophylaxis ◽  
Catheter Replacement

OBJECTIVE External ventricular drainage (EVD) catheters are associated with complications such as EVD catheter infection (ECI), intracranial hemorrhage (ICH), and suboptimal placement. The aim of this study was to investigate the rates of EVD catheter complications and their associated risk factor profiles in order to optimize the safety and accuracy of catheter insertion. METHODS A total of 348 patients with urgently placed EVD catheters were included as a part of a prospective multicenter observational cohort. Strict definitions were applied for each complication category. RESULTS The rates of misplacement, ECI/ventriculitis, and ICH were 38.6%, 12.2%, and 9.2%, respectively. Catheter misplacement was associated with midline shift (p = 0.002), operator experience (p = 0.031), and intracranial length (p < 0.001). Although mostly asymptomatic, ICH occurred more often in patients receiving prophylactic low-molecular-weight heparin (LMWH) (p = 0.002) and those who required catheter replacement (p = 0.026). Infectious complications (ECI/ventriculitis and suspected ECI) occurred more commonly in patients whose catheters were inserted at the bedside (p = 0.004) and those with smaller incisions (≤ 1 cm) (p < 0.001). ECI/ventriculitis was not associated with preinsertion antibiotic prophylaxis (p = 0.421), catheter replacement (p = 0.118), and catheter tunneling length (p = 0.782). CONCLUSIONS EVD-associated complications are common. These results suggest that the operating room setting can help reduce the risk of infection, but not the use of preoperative antibiotic prophylaxis. Although EVD-related ICH was associated with LMWH prophylaxis for deep vein thrombosis, there were no significant clinical manifestations in the majority of patients. Catheter misplacement was associated with operator level of training and midline shift. Information from this multicenter prospective cohort can be utilized to increase the safety profile of this common neurosurgical procedure.

scholarly journals Carbapenemases: Transforming Acinetobacter baumannii into a Yet More Dangerous Menace

Biomolecules ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. 720 ◽  
Author(s):  
Maria Soledad Ramirez ◽  
Robert A. Bonomo ◽  
Marcelo E. Tolmasky
Keyword(s):  
Acinetobacter Baumannii ◽  
Nosocomial Infections ◽  
Acquired Resistance ◽  
Clinical Manifestations ◽  
High Capacity ◽  
Bloodstream Infections ◽  
Multidrug Resistant ◽  
Drug Resistant ◽  
Wound Infections ◽  
Extensively Drug Resistant

Acinetobacter baumannii is a common cause of serious nosocomial infections. Although community-acquired infections are observed, the vast majority occur in people with preexisting comorbidities. A. baumannii emerged as a problematic pathogen in the 1980s when an increase in virulence, difficulty in treatment due to drug resistance, and opportunities for infection turned it into one of the most important threats to human health. Some of the clinical manifestations of A. baumannii nosocomial infection are pneumonia; bloodstream infections; lower respiratory tract, urinary tract, and wound infections; burn infections; skin and soft tissue infections (including necrotizing fasciitis); meningitis; osteomyelitis; and endocarditis. A. baumannii has an extraordinary genetic plasticity that results in a high capacity to acquire antimicrobial resistance traits. In particular, acquisition of resistance to carbapenems, which are among the antimicrobials of last resort for treatment of multidrug infections, is increasing among A. baumannii strains compounding the problem of nosocomial infections caused by this pathogen. It is not uncommon to find multidrug-resistant (MDR, resistance to at least three classes of antimicrobials), extensively drug-resistant (XDR, MDR plus resistance to carbapenems), and pan-drug-resistant (PDR, XDR plus resistance to polymyxins) nosocomial isolates that are hard to treat with the currently available drugs. In this article we review the acquired resistance to carbapenems by A. baumannii. We describe the enzymes within the OXA, NDM, VIM, IMP, and KPC groups of carbapenemases and the coding genes found in A. baumannii clinical isolates.

Shunt surgery for hydrocephalus in tuberculous meningitis: a long-term follow-up study

1991 ◽  
Vol 74 (1) ◽  
pp. 64-69 ◽  
Author(s):  
Ravi Palur ◽  
Vedantam Rajshekhar ◽  
Mathew J. Chandy ◽  
Thomas Joseph ◽  
Jacob Abraham
Keyword(s):  
Tuberculous Meningitis ◽  
External Ventricular Drainage ◽  
Shunt Surgery ◽  
Ventricular Drainage ◽  
Initial Examination ◽  
Long Term Outcome ◽  
Long Term Follow Up ◽  
Grade Iii

✓ Hydrocephalus is a common complication of tuberculous meningitis. Case studies of 114 patients with tuberculous meningitis and hydrocephalus, who underwent shunt surgery between July, 1975, and June, 1986, were reviewed to evaluate the long-term outcome and to outline a management protocol for these patients based on the results. Seven factors were studied in each case: 1) age at admission; 2) grade on admission (I to IV, classified by the authors: Grade I being the best and Grade IV being the worst); 3) duration of alteration of sensorium; 4) cerebrospinal fluid (CSF) cell content at initial examination; 5) CSF protein levels at initial examination; 6) number of shunt revisions required; and 7) the necessity for bilateral shunts. During a long-term follow-up period ranging from 6 months to 13 years (mean 45.6 months), the mortality rate was 20% for patients in Grade I; 34.7% for patients in Grade II; 51.9% for patients in Grade III; and 100% for patients in Grade IV. Only the grade at the time of admission was found to be statistically significant in determining final outcome (p < 0.001). Based on these results, the authors advocate early shunt surgery for Grade I and II patients. For patients in Grade III, surgery may be performed either if external ventricular drainage causes an improvement in sensorium or without selection. All patients in Grade IV should undergo external ventricular drainage and only those who show a significant change in their neurological status within 24 to 48 hours of drainage, should have shunt surgery.

Acute hydrocephalus in posterior fossa injury

1997 ◽  
Vol 86 (4) ◽  
pp. 629-632 ◽  
Author(s):  
Hideharu Karasawa ◽  
Hajime Furuya ◽  
Hiromichi Naito ◽  
Ken Sugiyama ◽  
Junji Ueno ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Fourth Ventricle ◽  
Ct Scanning ◽  
Mortality Rates ◽  
External Ventricular Drainage ◽  
Ventricular Drainage ◽  
Content Type ◽  
Acute Hydrocephalus ◽  
Significant Difference ◽  
Fine Print

✓ This is the first known report of the use of computerized tomography (CT) scanning to examine acute hydrocephalus in posterior fossa injury. Of the 1802 patients with acute head trauma treated at Funabashi Municipal Medical Center, 53 (2.9%) had suffered injury to the posterior fossa. Of these, 12 patients (22.6%) had associated acute hydrocephalus: nine patients with acute epidural hematoma (AEH) and three with intracerebellar hematoma and contusion (IH/C). There was a significant relationship between cases of AEH with hydrocephalus and supratentorial extension, hematoma thickness of 15 mm or more, and abnormal mesencephalic cisterns. In cases of IH/C, bilateral lesions and no visible fourth ventricle were significant causes of hydrocephalus. According to these results, possible mechanisms of acute hydrocephalus in posterior fossa injury may be as follows: in cases of AEH, hematoma that extends to the supratentorial area compresses the aqueduct posteriorly and causes hydrocephalus; in cases of IH/C, hematoma and contusional lesions may directly occlude the fourth ventricle and cause acute hydrocephalus. Seven patients suffering from AEH with acute hydrocephalus underwent evacuation of their hematoma without external ventricular drainage. In these cases, CT scanning showed that the hydrocephalus improved immediately after evacuation of the hematoma. Two patients suffering from IH/C with hydrocephalus underwent a procedure for evacuation of the hematoma and external ventricular drainage. The authors do not believe that ventricular drainage is necessary in treating posterior fossa AEH. However, both evacuation of the hematoma and ventricular drainage are necessary in cases of IH/C with hydrocephalus to provide the patient with every chance for survival. There was no significant difference in mortality rates when cases of AEH with acute hydrocephalus (0%) were compared with cases of AEH without hydrocephalus (7.7%). The observed mortality rates in cases of IH/C with hydrocephalus and those without hydrocephalus were 100% and 15.4%, respectively; this is statistically significant.

Risk factors for hydrocephalus requiring external ventricular drainage in patients with intraventricular hemorrhage

2015 ◽  
Vol 123 (6) ◽  
pp. 1439-1446 ◽  
Author(s):  
Joshua D. Hughes ◽  
Ross Puffer ◽  
Alejandro A. Rabinstein
Keyword(s):  
Fourth Ventricle ◽  
Intraventricular Hemorrhage ◽  
Third Ventricle ◽  
External Ventricular Drainage ◽  
Ventricular Drainage ◽  
Operating Characteristics ◽  
Chi Square ◽  
Study Population ◽  
Student’S T ◽  
Gcs Score

OBJECT External ventricular drainage (EVD) after intraventricular hemorrhage (IVH) without symptomatic hydrocephalus is controversial. The object of this study was to examine indicators or the timeframe for hydrocephalus in patients not immediately treated with EVD after IVH. METHODS Records from 2007 to 2014 were searched for “intraventricular hemorrhage” or “IVH.” Inclusion criteria were IVH after intracerebral hemorrhage (ICH), trauma, tumor, or vascular anomalies. Exclusion criteria were IVH with more than minimal subarachnoid hemorrhage, catastrophic ICH, layering IVH only, or hydrocephalus treated immediately with EVD. IVH was measured with the modified Graeb Score (mGS). An mGS of 5 indicates a full ventricle with dilation. Statistics included chi-square, Student’s t-test, and Mann-Whitney tests; receiver operating characteristics; and uni- and multivariate logistic regression. RESULTS One hundred five patients met the criteria; of these, 30 (28.6%) required EVD. Panventricular IVH was the most common pattern (n = 49, 46.7%), with 25 of these patients (51%) requiring EVD. The median mGS was 18 ± 5.4 (range 12–29) and 9 ± 4.5 (range 2–21) in the EVD and No-EVD groups, respectively (p < 0.001). Factors associated with EVD were radiological hydrocephalus at presentation, midline shift > 5 mm, Glasgow Coma Scale (GCS) score < 8, mGS > 13, third ventricle mGS = 5, and fourth ventricle mGS = 5. On multivariate analysis, GCS score < 8 [4.02 (range 1.13–14.84), p = 0.032], mGS > 13 [3.83 (range 1.02–14.89), p = 0.046], and fourth ventricle mGS = 5 [5.01 (range 1.26–22.78), p = 0.022] remained significant. Most patients treated with EVD (n = 25, 83.3%) required it soon after presentation [6.4 ± 3.3 (range 1.5–14) hrs]. The remaining 5 patients (16.7%) had a delayed EVD requirement [70.7 ± 22.7 (range 50–104.5) hrs]. CONCLUSIONS In this study population, the risk for EVD was variable, but greater with mGS > 13, coma, and a dilated fourth ventricle. While the need for EVD occurs within the 1st day after IVH in most patients, a minority require EVD after 48 hours.

Temporary ventricular drainage and emergency radiotherapy in the management of hydrocephalus associated with germinoma

2002 ◽  
Vol 96 (6) ◽  
pp. 1020-1022 ◽  
Author(s):  
John M. Buatti ◽  
William A. Friedman
Keyword(s):  
Obstructive Hydrocephalus ◽  
External Ventricular Drainage ◽  
Tumor Control ◽  
Ventricular Drainage ◽  
Content Type ◽  
Fractionated Radiotherapy ◽  
Novel Strategy ◽  
Emergency Radiotherapy ◽  
Fine Print

Object. The authors used an alternative strategy to avoid shunt placement for hydrocephalus associated with germinoma, and the ensuing complications. Methods. Between 1998 and 2000, five patients presenting with germinomas of the pineal area and symptomatic obstructive hydrocephalus were treated with a novel strategy. On arrival, they underwent ventriculostomy placement and one of several surgical procedures to obtain tissue for diagnosis. Within several days of the initial diagnosis, stereotactically guided fractionated radiotherapy was started. All patients experienced rapid tumor shrinkage and resolution of hydrocephalus, allowing discontinuation of external ventricular drainage without the need for permanent shunting of cerebrospinal fluid. To date, follow up reveals 100% radiographically and clinically confirmed tumor control. Conclusions. Prompt resolution of hydrocephalus and absence of complications make this a potentially valuable therapy for control of germinomas and their symptoms.

scholarly journals Successful Treatment of Postneurosurgical Ventriculitis Caused by Extensively Drug-resistant Acinetobacter baumannii in a Child: Case Report

2022 ◽  
Vol 14 (2) ◽  
Author(s):  
Rui Yang ◽  
Fang Li ◽  
Wei Wei Mao ◽  
Xin Wei ◽  
Xinzhu Liu ◽  
...  
Keyword(s):  
Acinetobacter Baumannii ◽  
Intraventricular Hemorrhage ◽  
Therapeutic Option ◽  
Polymyxin B ◽  
External Ventricular Drainage ◽  
Drug Resistant ◽  
Ventricular Drainage ◽  
Extensively Drug Resistant ◽  
Resistant Strains ◽  
Drug Resistant Strains

Introduction: The incidence of postneurosurgical Acinetobacter baumannii ventriculitis/meningitis, primarily due to drug-resistant strains, has increased considerably in recent years. However, limited therapeutic options are available because most antibiotics poorly penetrate the blood-brain barrier, especially in pediatric patients. Case Presentation: A five-year-old boy developed ventriculitis due to extensively drug-resistant A. baumannii (XDRAB) after bilateral frontal external ventricular drainage for spontaneous intraventricular hemorrhage. The boy was safely and successfully treated with intraventricular (IVT)/intrathecal (ITH) polymyxin B together with intravenous tigecycline plus cefoperazone/sulbactam. Conclusions: In the present case, postneurosurgical XDRAB ventriculitis was closely associated with intraventricular hemorrhage and the placement of external ventricular drainage. IVT/ITH polymyxin B combined with intravenous tigecycline and cefoperazone sulbactam could be a therapeutic option against XDRAB ventriculitis in children.

Prolonged Therapeutic External Ventricular Drainage: A Prospective Study

Neurosurgery ◽  
1988 ◽  
Vol 23 (4) ◽  
pp. 436-438 ◽  
Author(s):  
Kwan-Hon Chan ◽  
Kirpal S. Mann
Keyword(s):  
Prospective Study ◽  
External Ventricular Drainage ◽  
Ventricular Catheter ◽  
Ventricular Drainage ◽  
Ventriculoperitoneal Shunts ◽  
The Mean ◽  
A Prospective Study

Abstract Over a 2½-year period, 34 patients underwent therapeutic external ventricular drainage with a valve-regulated system. The mean duration of drainage was 16 days. There was no incidence of ventricular infection, nor was there blockage of the ventricular catheter requiring revision. Eventually, 13 patients required ventriculoperitoneal shunts. All survivors remained free from complications after more than 6 months of follow-up. The system proved safe and reliable in patients requiring prolonged ventricular drainage.

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