Analysis of risk factors and preventive strategies for intracranial infection after neuroendoscopic transnasal pituitary adenoma resection

Objective To analyse the risk factors for intracranial infection after neuroendoscopic transnasal pituitary adenoma resection (NTPAR) to provide a reference for the prevention and treatment of postoperative intracranial infection. Methods The clinical data of 387 patients who underwent NTPAR in the Department of Neurosurgery of the First People’s Hospital of Yichang from March 2013 to March 2021 were retrospectively analysed. The patients were divided into an infected group and a noninfected group according to the occurrence of intracranial infection. The detailed clinical data of the two groups were collected. Univariate and multivariate logistic regression was used to analyse the risk factors for intracranial infection after NTPAR. Results Among the 387 surgical patients, 32 patients (8.27%) were in the intracranially infected group and 355 patients (91.73%) were in the noninfected group. The results of the univariate analysis suggested that age > 45 years, tumour size > 1 cm, operation time > 240 min, blood loss > 400 ml, Kelly Grade of cerebrospinal fluid (CSF) leakage > Grade 2, postoperative CSF leakage, lumbar cistern drainage and blood transfusion were the influencing factors for postoperative intracranial infection, while the results of multivariate logistic regression analysis implied that intraoperative CSF leakage (Kelly Grade > 2) and postoperative CSF leakage were independent influencing factors for intracranial infection after NTPAR, and perioperative use of antibiotics was an independent protective factor for postoperative intracranial infection. Conclusions There are a variety of risk factors for intracranial infection after NTPAR, which indicates that it is necessary to develop different repair strategies for CSF leakage according to the Kelly Grade, timely treatment of postoperative CSF leakage and perioperative use of antibiotics. These measures have been shown to effectively reduce the probability of intracranial infection after NTPAR.

Elizabethkingia miricola Causes Intracranial Infection: A Case Study

Background:Elizabethkingia miricola is a rarely encountered bacterium in clinical practice. It is a rare gram-negative rod-shaped bacterium associated with lung and urinary tract infections, but never found in cerebrospinal fluid. This paper reports a case of an adult patient infected by E. miricola via an unknown route of infection causing a severe intracranial infection. Elizabethkingia miricola was detected by culture and Metagenomic next generation sequencing in CSF. Early identification of this strain and treatment with sensitive antibiotics is necessary to reduce morbidity and mortality.Case Report: A 24-year-old male was admitted to a West China Hospital because of headache and vomiting for 2 months. Symptom features included acute onset and long duration of illness. Notably, headache and vomiting were the primary neurological symptoms. Routine cerebrospinal fluid culture failed to identify the bacterium; however, Elizabethkingia miricola bacterium was detected via second-generation sequencing techniques. Elizabethkingia miricola was found to be a multi-drug resistant organism, hence, treatment with ceftriaxone, a commonly used drug for intracranial infections was ineffective. This strain eventually caused severe intracranial infection resulting in the death of the patient.Conclusion: In summary, this study comprehensively describes a case of an adult patient infected by E. miricola and discusses its early identification as well as application of sensitive antibiotics in the emergency setting.

Analysis of Clinical Characteristics and Prognosis of Traumatic Brain Injury in Papua New Guinea

Objective. To evaluate the clinical characteristics and prognosis of TBI patients from 2016 to 2019 admitted to Port Moresby General Hospital (PMGH) of Papua New Guinea (PNG) and compare the results with previous researches to analyze current clinical characteristics and prognosis. Methods. A retrospective study was performed on 389 TBI patients in Port Moresby General Hospital (PMGH) over a 48-month period (from January 2016 to December 2019). The clinical and radiographic data were collected. Patients were followed up for at least 3 months, and outcomes were assessed using the Glasgow Outcome Scale (GOS). Univariate and multivariate logistic regressions were performed to analyze the prognosis and intracranial infection of patients, as well as the effect of surgery on the prognosis of TBI patients. Results. The average age of the 389 TBI patients was 24.9 years old, and the most common age was 18-40 years old, accounting for 55.5%. The proportion of male patients was 79.4%, and the proportion of juvenile patients (≤18 years) was 30.8%. The most primary cause of injury was fighting and brawling (38.0%). At admission, patients had an average GCS score of 9.1, and patients with severe TBI accounted for 46.8%. Overall, 32.1% of the patients had a good prognosis, with a mortality rate of 13.9% (54 cases). Analyzing the relationship between surgical treatment and prognosis in 303 patients with moderate or severe TBI, there was no statistical significance. Univariate and logistic regression analyses for poor prognosis included gender, GCS, multiple injuries, Rotterdam CT scores, and intracranial infection. Univariate and logistic regression analyses for intracranial infection included GCS, open brain trauma, and postoperative drainage time. Conclusion. Despite there has been a secular trend towards reduced incidence of TBI, the prognosis of moderate or severe TBI patients who received surgery showed no significant improvement, indicating that PNG, as a backward developing country, faced a huge problem in TBI prevention and control.

Intracranial Infection Caused by Multidrug-resistant Acinetobacter Baumannii

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.

Prevalence and Associated Factors of Malnutrition in Patients with Intracranial Infections at Sanglah Hospital Denpasar

Malnutrition is a major health problem in developing countries, it can occur acutely, chronically or combination of both. Malnutrition aggravates the condition of infectious diseases, including intracranial infections. Hereby we aimed to determine the prevalence and factors associated with malnutrition in pediatric patients with intracranial infections in Sanglah Central General Hospital. This cross-sectional analytic study was conducted in patients with final diagnosis intracranial infection whom were treated from January 2019 to March 2021. The study was conducted in pediatric patients aged 1 month-18 years old and patient would be excluded if had any of these conditions: 1) incomplete medical records, 2) discharge by his/her own request, 3) hydrocephalus for which VP shunt had not been performed, 4) diagnosis of tumor or mass that could affect body weight measurement. Secondary data such as weight/height for children <5 years and BMI/age for children >5 years were measured in growth curve by using the WHO Anthro application. Total samples were 83 children with predominance age group was 0-5 years old. Malnutrition was found in 48.1% patients. Chronic malnutrition was more common than acute malnutrition (32.5% vs. 31.3%). Age below 5 years has relationship with the incidence of acute malnutrition in pediatric patients with intracranial infection (p: 0.008, 95% CI: 0.076-0.675). The incidence of malnutrition in children with intracranial infections in Sanglah Hospital during January 2019 to March 2021 was 48.1%, and age < 5 years had significant relation to the incidence of malnutrition in children with intracranial infections.

Analysis of Risk Factors of Intracranial Infection After Traumatic Brain Injury Surgery

Background: Craniocerebral operation is the main method for the treatment of traumatic brain injury. However, it is very easy to be complicated with intracranial infection after operation, which affects the surgical efficacy and patient’s prognosis. It is also the main cause of surgical failure. It may also cause patient’s death for some patients with serious diseases. It is found that the infection after craniocerebral operation is often accompanied with abnormal changes of body-related treatment, in which the changes of serological indicators are more significant. Therefore, it is helpful to provide guidance for the prevention and judgment of patient’s postoperative infection by analyzing the patient’s serological indicators. Objective: To investigate the risk factors of intracranial infection and the levels of serum procalcitonin (PCT) and endothelin-1 (ET-1) in patients after traumatic brain injury. Methods: From January 2018 to January 2021, 58 patients with intracranial infection after traumatic brain injury (infection group) were selected, and 116 patients without intracranial infection after traumatic brain injury (non-infection group) were selected. The difference of clinical data between the two groups was analyzed. Serum PCT and ET-1 levels were measured in the two groups. Results: In the infection group, admission GCS scoring <8 points, operation time ≥4h, indwelling time of drainage tube ≥ 2d, preoperative ALB <35g/ L, mechanical ventilation and cerebrospinal fluid leakage were 63.79%, 72.41%, 43.10%, 68.97%, 32.76% and 68.97% respectively, which were obviously higher than those in the non-infection group (P<0.05). Logistic regression analysis results showed that admission GCS scoring, operation time, indwelling time of drainage tube, preoperative ALB, mechanical ventilation and cerebrospinal fluid leakage were the influencing factors of intracranial infection after traumatic brain injury (OR = 0.712,1.556,1.451,0.641,1.954 and 1.667, P<0.05); serum PCT and ET-1 in the infection group were (0.83 ± 0.20) mg/L and (0.87 ± 0.23) ng/L, respectively, which were significantly higher than those in the non-infection group (P<0.05); serum PCT and ET-1 in patients with different sex, age and pathogen had no significant difference (P>0.05); serum PCT and ET-1 area under ROC curve were 0.828 and 0.751, respectively P<0.05. Conclusion: The intracranial infection of patients with traumatic brain injury are affected by many factors including, admission GCS scoring, operation time, and so on, the levels of serum PCT and ET-1 in patients with intracranial infection are increased, which may be useful in predicting intracranial infection.

Case Report: Diagnostic Value of Metagenomics Next Generation Sequencing in Intracranial Infection Caused by Mucor

mNGS(metagenomics Next Generation Sequencing), as a novel culture-independent approach, demonstrated the capability of rapid, sensitive, and accurate pathogen identification. At present, there have been many case reports about the use of mNGS to assist in the diagnosis of bacterial, fungal, viral and parasitic infections and to guide clinicians to determine appropriate treatment. However, the clinical understanding of this technique is not comprehensive, and the experience of using it is relatively limited. We reported a 53-year-old man who was admitted to hospital with a high fever and headache. His inflammatory biomarkers were markedly elevated. Based on the clinical presentation, He was initially diagnosed as having an intracranial infection of unknown etiology and received empirical antibiotics and systemic supportive treatment. But these did not relieve his symptoms. Both the blood and CSF specimens were examined using traditional culture, serological testing, and mNGS. Traditional culture and serological testing produced negative results, while the mNGS revealed the presence of a potential pathogen, mucor, in the CSF specimen. Then targeted antifungal treatment was selected quickly and his temperature gradually returned to normal. Thus, we report the case in which mNGS was an auxiliary method to diagnose mucormycosis, and discuss this case in combination with relevant literature, in order to improve the clinical cognition of this technology.

Strategies for Persistent Intracranial Infection Associated With Subcutaneous Effusion in the Posterior Fossa

Objective: Due to the particularity of anatomy, there are many subcutaneous effusions after posterior fossa surgery. This paper discusses the characteristics and treatment strategies of persistent infection related to subcutaneous effusions in the posterior fossa. Methods: Seventeen patients with persistent intracranial infection after neurosurgical posterior fossa surgery from March 2015 to July 2020 were retrospectively analyzed. According to different stages of infection, the treatment process of intracranial infection was divided into the acute infection stage, clinical response stage and infection cure stage, and the measures taken in the different stages were summarized.Results: Compared with the acute infection stage, the indices of body temperature, blood and cerebrospinal fluid in the clinical response stage were improved, but there was no significant difference. There was a significant difference in each index between the acute infection stage and the infection cure stage. After the infection was cured, 17 patients were significantly relieved or cured of subcutaneous effusions by various methods.Conclusion: It is necessary to be alert to the existence of subcutaneous effusions in cases of poor effects or repeated infections after routine treatment. Multiple replacements and flushing of subcutaneous effusions are an important means of treating this kind of infection.