■由多药耐药(MDR)革兰氏阴性杆菌引起的医院感染性脑室炎与外部脑室引流(EVD)放置相关,会带来巨大的死亡率负担和住院费用。
■本研究旨在分析其特征,脑室炎的演变,治疗,以及与EVD放置相关的MDR革兰氏阴性杆菌引起的脑室炎患者的结局。
■于2019年至2022年进行了一项回顾性队列研究,重点研究了由MDR革兰氏阴性杆菌引起的医院感染患者,同时进行了EVD。医疗,实验室,并收集微生物记录。分析了患者脑脊液(CSF)中分离的革兰氏阴性杆菌的抗生素耐药性。使用单变量风险模型识别风险因素,并使用生存曲线(Cox回归)进行分析。还构建了调整后的Cox比例风险模型。
■在530名疑似EVD相关脑室炎患者中,包括64例脑脊液中分离出革兰氏阴性杆菌的患者。估计死亡率为78.12%。出血(颅内,蛛网膜下腔,和心室内)在69.8%的患者中观察到。鲍曼不动杆菌,肺炎克雷伯菌,铜绿假单胞菌是最常见的分离杆菌。在单变量分析中,死亡的重要危险因素包括动脉高血压,格拉斯哥昏迷量表(GCS)评分≤8分,入院时和住院期间有创机械通气(IMV),感染性休克,无效的治疗。调整后的Cox比例风险模型显示,感染性休克(HR=3.3,95%CI=1.5-7.2;p=0.003)和无效治疗(HR=3.2,1.6-6.5,0.001)是显着预测因素。鲍曼不动杆菌(91.3%)和铜绿假单胞菌(80.0%)对碳青霉烯类抗生素有较高的耐药性。鲍曼不动杆菌(4.8%)和铜绿假单胞菌(12.5%)对粘菌素的抗性低。
■无效治疗是MDR革兰阴性杆菌所致脑室炎患者与EVD相关的独立危险因素。
UNASSIGNED: Nosocomial infectious ventriculitis caused by multidrug-resistant (MDR) Gram-negative bacilli associated with external ventricular drainage (EVD) placement poses a significant mortality burden and hospital costs.
UNASSIGNED: This study aims to analyze the characteristics, ventriculitis evolution, treatment, and outcomes of patients with ventriculitis due to MDR Gram-negative bacilli associated with EVD placement.
UNASSIGNED: A retrospective cohort study focusing on patients with nosocomial infection caused by MDR Gram-negative bacilli while on EVD was conducted from 2019 to 2022. Medical, laboratory, and microbiological records were collected. The antibiotic resistance of the Gram-negative bacilli isolated in the cerebrospinal fluid (CSF) of patients was analyzed. The risk factors were identified using univariate risk models and were analyzed using survival curves (Cox regression). An adjusted Cox proportional hazards model was also constructed.
UNASSIGNED: Among 530 patients with suspected EVD-associated ventriculitis, 64 patients with isolation of Gram-negative bacilli in CSF were included. The estimated mortality was 78.12%. Hemorrhages (intracranial, subarachnoid, and intraventricular) were observed in 69.8% of patients. Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa were the most frequently isolated bacilli. In the univariate analysis, significant risk factors for mortality included arterial hypertension, a Glasgow Coma Scale (GCS) score of ≤ 8, invasive mechanical ventilation (IMV) upon hospital admission and during hospitalization, septic shock, and ineffective treatment. The adjusted Cox proportional hazards model revealed that septic shock (HR = 3.3, 95% CI = 1.5-7.2; p = 0.003) and ineffective treatment (HR = 3.2, 1.6-6.5, 0.001) were significant predictors. A high resistance to carbapenems was found for A. baumannii (91.3%) and P. aeruginosa (80.0%). Low resistance to colistin was found for A. baumannii (4.8%) and P. aeruginosa (12.5%).
UNASSIGNED: Ineffective treatment was an independent hazard factor for death in patients with ventriculitis caused by MDR Gram-negative bacilli associated with EVD.