Open Access

Efficacy and safety of intrathecal meropenem and vancomycin in the treatment of postoperative intracranial infection in patients with severe traumatic brain injury

  • Authors:
    • Qiang Zhang
    • Hongxing Chen
    • Chao Zhu
    • Fangzhou Chen
    • Suohui Sun
    • Nan Liang
    • Wei Zheng
  • View Affiliations

  • Published online on: April 18, 2019     https://doi.org/10.3892/etm.2019.7503
  • Pages: 4605-4609
  • Copyright: © Zhang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )
Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )


Abstract

This study investigated the improvement and safety of intrathecal meropenem and vancomycin in the treatment of postoperative intracranial infection in patients with severe traumatic brain injury (STBI). A retrospective analysis was performed on 86 patients with intracranial infections after cranial trauma operation in Tai'an Traditional Chinese Medicine Hospital and Affiliated Hospital of Taishan Medical University from May 2004 to June 2017. The patients were divided into the control group (43 patients) and the experimental group (43 patients) according to the treatment. Patients in the control group were intravenously infused with vancomycin hydrochloride (1.0 g, Q12H) and meropenem (2.0 g, Q8H). After lumbar cistern drainage was performed for the release of cerebrospinal fluid (CSF), patients in the experimental group were slowly given vancomycin 20 mg. After the tube was flushed with 2 ml of 0.9% sodium chloride injection, the patients were slowly given meropenem 20 mg, bid. The clinical efficacy, cure time and treatment cost of patients in the two groups were observed. The adverse reactions and sequelae after 6 months of treatment were recorded. The response rate (RR) of patients in the experimental group was significantly higher than that in the control group (P<0.05). The cure time of patients in the experimental group was significantly lower than that in the control group (P<0.05). The treatment cost of patients in the experimental group was significantly lower than that in the control group (P<0.05). The incidence of adverse reactions of patients, incidence of sequelae of patients in the experimental group was significantly lower than that in the control group (P<0.05). Intrathecal meropenem and vancomycin is more effective than intravenous administration in the treatment of intracranial infection after craniotomy. It can significantly shorten the treatment time and reduce the treatment cost, with better safety.

References

1 

Gupta MK, Mondkar JA and Hegde D: Paradoxical reaction to midazolam in preterm neonates: A case series. Indian J Crit Care Med. 22:300–302. 2018. View Article : Google Scholar : PubMed/NCBI

2 

Dey S and Kumar M: Comparison of pretreatment with dexmedetomidine with midazolam for prevention of etomidate-induced myoclonus and attenuation of stress response at intubation: A randomized controlled study. J Anaesthesiol Clin Pharmacol. 34:94–98. 2018.PubMed/NCBI

3 

Paleti S, Prasad PK and Lakshmi BS: A randomized clinical trial of intrathecal magnesium sulfate versus midazolam with epidural administration of 0.75% ropivacaine for patients with preeclampsia scheduled for elective cesarean section. J Anaesthesiol Clin Pharmacol. 34:23–28. 2018.PubMed/NCBI

4 

Azeem TM, Yosif NE, Alansary AM, Esmat IM and Mohamed AK: Dexmedetomidine vs morphine and midazolam in the prevention and treatment of delirium after adult cardiac surgery; a randomized, double-blinded clinical trial. Saudi J Anaesth. 12:190–197. 2018. View Article : Google Scholar : PubMed/NCBI

5 

Mazzeo AT, Filippini C, Rosato R, Fanelli V, Assenzio B, Piper I, Howells T, Mastromauro I, Berardino M, Ducati A, et al: Multivariate projection method to investigate inflammation associated with secondary insults and outcome after human traumatic brain injury: A pilot study. J Neuroinflammation. 13:1572016. View Article : Google Scholar : PubMed/NCBI

6 

Goldschmidt E, Rasmussen J, Chabot JD, Gandhoke G, Luzzi E, Merlotti L, Proni R, Loresi M, Hamilton DK, Okonkwo DO, et al: The effect of vancomycin powder on human dural fibroblast culture and its implications for dural repair during spine surgery. J Neurosurg Spine. 25:665–670. 2016. View Article : Google Scholar : PubMed/NCBI

7 

Blassmann U, Roehr AC, Frey OR, Vetter-Kerkhoff C, Thon N, Hope W, Briegel J and Huge V: Cerebrospinal fluid penetration of meropenem in neurocritical care patients with proven or suspected ventriculitis: a prospective observational study. Crit Care. 20:3432016. View Article : Google Scholar : PubMed/NCBI

8 

Caughlin S, Maheshwari S, Agca Y, Agca C, Harris AJ, Jurcic K, Yeung KK, Cechetto DF and Whitehead SN: Membrane-lipid homeostasis in a prodromal rat model of Alzheimers disease: Characteristic profiles in ganglioside distributions during aging detected using MALDI imaging mass spectrometry. Biochim Biophys Acta, Gen Subj. 1862:1327–1338. 2018. View Article : Google Scholar

9 

Benktander J, Barone A, Johansson MM and Teneberg S: Helicobacter pylori SabA binding gangliosides of human stomach. Virulence. 9:738–751. 2018. View Article : Google Scholar : PubMed/NCBI

10 

Sasaki N, Itakura Y and Toyoda M: Ganglioside GM1 contributes to extracellular/intracellular regulation of insulin resistance, impairment of insulin signaling and down-stream eNOS activation, in human aortic endothelial cells after short- or long-term exposure to TNFα. Oncotarget. 9:5562–5577. 2017.PubMed/NCBI

11 

Iwasawa T, Zhang P, Ohkawa Y, Momota H, Wakabayashi T, Ohmi Y, Bhuiyan RH and Furukawa K and Furukawa K: Enhancement of malignant properties of human glioma cells by ganglioside GD3/GD2. Int J Oncol. 52:1255–1266. 2018.PubMed/NCBI

12 

Patet C, Suys T, Carteron L and Oddo M: Cerebral lactate metabolism after traumatic brain injury. Curr Neurol Neurosci Rep. 16:312016. View Article : Google Scholar : PubMed/NCBI

13 

Hackenberg K and Unterberg A: Traumatic brain injury. Nervenarzt. 87:203–214; quiz 215–216, 2016 (In German). View Article : Google Scholar : PubMed/NCBI

14 

Duan M, Wang D, Wang J, Xiao X, Han L and Zhang F: A case report of intracranial infection caused by Shewanella putrefaciens. Neurol Sci. 36:625–629. 2015. View Article : Google Scholar : PubMed/NCBI

15 

Cook AM, Arora S, Davis J and Pittman T: Augmented renal clearance of vancomycin and levetiracetam in a traumatic brain injury patient. Neurocrit Care. 19:210–214. 2013. View Article : Google Scholar : PubMed/NCBI

16 

Huttner HB, Nagel S, Tognoni E, Köhrmann M, Jüttler E, Orakcioglu B, Schellinger PD, Schwab S and Bardutzky J: Intracerebral hemorrhage with severe ventricular involvement: Lumbar drainage for communicating hydrocephalus. Stroke. 38:183–187. 2007. View Article : Google Scholar : PubMed/NCBI

17 

Wattanathum A, Chaoprasong C, Nunthapisud P, Chantaratchada S, Limpairojn N, Jatakanon A and Chanthadisai N: Community-acquired pneumonia in southeast Asia: The microbial differences between ambulatory and hospitalized patients. Chest. 123:1512–1519. 2003. View Article : Google Scholar : PubMed/NCBI

18 

El Sayed Zaki M and Goda T: Clinico-pathological study of atypical pathogens in community-acquired pneumonia: A prospective study. J Infect Dev Ctries. 3:199–205. 2009. View Article : Google Scholar : PubMed/NCBI

19 

Gaillat J, Flahault A, deBarbeyrac B, Orfila J, Portier H, Ducroix JP, Bébéar C and Mayaud C: Community epidemiology of Chlamydia and Mycoplasma pneumoniae in LRTI in France over 29 months. Eur J Epidemiol. 20:643–651. 2005. View Article : Google Scholar : PubMed/NCBI

20 

Doder R, Canak G, Vukadinov J, Turkulov V and Sević S: Antibiotics in the treatment of bacterial infections of the central nervous system. Med Pregl. 63 (Suppl 1):22–26. 2010.PubMed/NCBI

21 

Kneen R, Solomon T and Appleton R: The role of lumbar puncture in suspected CNS infection - a disappearing skill? Arch Dis Child. 87:181–183. 2002. View Article : Google Scholar : PubMed/NCBI

22 

Bao Y, Qiu B, Zeng H, Mo Y, Zhang N and Qi S: Combined intravenous and intrathecal vancomycin in treatment of patients with intracranial infections after craniotomy. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 28:169–172. 2016.(In Chinese). PubMed/NCBI

23 

Lee K, Rho M, Yu M, Kwak J, Hong S, Kim J, Kim Y and Pai H: A case of recurrent meningitis caused by Rhodococcus species successfully treated with antibiotic treatment and intrathecal injection of vancomycin through an Ommaya reservoir. Infect Chemother. 47:183–189. 2015. View Article : Google Scholar : PubMed/NCBI

24 

Chen K, Wu Y, Wang Q, Wang J, Li X, Zhao Z and Zhou J: The methodology and pharmacokinetics study of intraventricular administration of vancomycin in patients with intracranial infections after craniotomy. J Crit Care. 30:218.e1–218.e5. 2015. View Article : Google Scholar

25 

Chen QH, Lin D, Yu QG and Zhou J: Efficacy of lumbar cistern drainage combined with intrathecal antibiotherapy for the treatment of ventriculo-subarachnoid infections following surgery for hypertensive intracerebral hemorrhage. Neurochirurgie. 63:13–16. 2017. View Article : Google Scholar : PubMed/NCBI

Related Articles

Journal Cover

June 2019
Volume 17 Issue 6

Print ISSN: 1792-0981
Online ISSN:1792-1015

Sign up for eToc alerts

Recommend to Library

Copy and paste a formatted citation
APA
Zhang, Q., Chen, H., Zhu, C., Chen, F., Sun, S., Liang, N., & Zheng, W. (2019). Efficacy and safety of intrathecal meropenem and vancomycin in the treatment of postoperative intracranial infection in patients with severe traumatic brain injury. Experimental and Therapeutic Medicine, 17, 4605-4609. https://doi.org/10.3892/etm.2019.7503
MLA
Zhang, Q., Chen, H., Zhu, C., Chen, F., Sun, S., Liang, N., Zheng, W."Efficacy and safety of intrathecal meropenem and vancomycin in the treatment of postoperative intracranial infection in patients with severe traumatic brain injury". Experimental and Therapeutic Medicine 17.6 (2019): 4605-4609.
Chicago
Zhang, Q., Chen, H., Zhu, C., Chen, F., Sun, S., Liang, N., Zheng, W."Efficacy and safety of intrathecal meropenem and vancomycin in the treatment of postoperative intracranial infection in patients with severe traumatic brain injury". Experimental and Therapeutic Medicine 17, no. 6 (2019): 4605-4609. https://doi.org/10.3892/etm.2019.7503