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

Figures & data

Table 1 Demographics of the Patients

Patients	N (%)
Total, N	28
Average age (mean ± sD) (range) (years)	44.64±17.42 (16–71)
Male	23/28 (82.1)
Female	5/28 (17.9)
Primary diagnosis
ICH	10/28 (35.7)
TBI	9/28 (32.1)
Aneurysm	4/28 (14.3)
Intracranial tumour	3/28 (10.7)
CVM	1/28 (3.6)
SAH	1/28 (3.6)
Surgical patients before infection	28/28 (100.0)
Any surgeries before infection
LD	21/28 (75.0)
EVD	20/28 (71.4)
More than 2 times EVD	7/28 (25.0)
Craniotomy	19/28 (67.9)
Hematoma evacuation	12/28 (42.9)
Decompressive craniectomy	11/28 (39.3)
VPS	5/28 (17.9)
Intracranial occupying resection	4/28 (14.3)
Ventriculoscopy	3/28 (10.7)
Cranioplasty	3/28 (10.7)
Aneurysm embolization	2/28 (7.1)
Aneurysm clipping	2/28 (7.1)
Ommaya implantation	1/28 (3.6)

Abbreviations: TBI, traumatic brain injury; ICH, intracerebral hemorrhage; CVM, cerebrovascular malformation; SAH, subarachnoid hemorrhage; EVD, external ventricular drainage; LD, lumbar drainage; VPS, ventriculoperitoneal shunt.

Table 2 Surgical Treatment and Local Administration of Intracranial Infection

Variables	N (%)
Operations
EVD	18/28 (55.9)
Retain the original EVD	16/28 (57.1)
Remove the LD	7/28 (25.0)
Remove the VPS	2/28 (7.1)
Remove the bone repair material	1/28 (3.6)
Intraventricular polymyxin B	28/28 (100.0)
Daily dose of Polymyxin B
5mg/daily	28/28 (100.0)
Duration of IVT Polymyxin B (mean ± SD) (range)(days)	14.96 ± 4.28 (9–23)

Abbreviations: EVD, external ventricular drainage; LD, lumbar drainage; VPS, ventriculoperitoneal shunt; IVT, intraventricular.

Table 3 Analysis of Cerebrospinal Fluid Pathogenic Bacteria and Drug Resistance in 28 Patients with Intracranial Infection by G-Bacilli

Antimicrobial Agent	Acinetobacter baumannii n =14	Klebsiella pneumoniae n=9	Pseudomonas aeruginosa n=3	Enterobacter cloacae n=2	Total n =28(%)
Amikacin	14	9	1	0	24/28 (85.7)
Carbapenem	13	8	3	1	25/28 (89.3)
Cephalosporin	14	8	2	2	26/28 (92.9)
Levofloxacin	14	7	2	2	25/28 (89.3)
Tigecycline	5	2	3	0	10/28 (35.7)
Cefoperazone sodium and sulbactam sodium	10	7	1	2	20/28 (71.4)
Gentamicin	12	8	1	2	23/28 (82.1)
Polymyxin B	0	0	0	0	0/28 (0.0)

Table 4 Clinical Symptoms and Laboratory Data in Patients

Laboratory Values	Before IVT Initiation	After Discontinuing IVT	P-value
Temperature >38°C	28/28 (100.0%)	5/28 (17.9%)	0.000
Neck stiffness	23/28 (82.1%)	14/28 (50.0%)	0.011
GCS
≥12	4/28 (14.3%)	9/28 (32.1%)
8–12	4/28 (14.3%)	7/28 (25.0%)
≤8	20/28 (71.4%)	12/28 (42.9%)	0.031
MRS
>4	24/28 (85.7%)	16/28 (57.1%)
≤4	4/28 (14.3%)	12/28 (42.9%)	0.018
Creatinine	44.75±16.68 (19.5–91)	48.64±13.01 (27.3–80.8)	0.115
CSF leukocyte count
Median (IQR), cells/*10-6/L	1610 (223,7480)	13 (8,84)	0.000
CSF glucose
Mean ±SD, mmol/L (range)	1.14±0.83 (0.01–2.69)	3.58±1.24 (0.51–6.2)	0.000
CSF chloride
Mean ±SD, mmol/L (range)	113.00±8.80 (92.5–125.2)	117.41±6.07 (99.6–126.1)	0.027
CSF protein
Mean ±SD, g/L (range)	3.00±1.43 (0.35–6.10)	1.30±0.54 (0.18–2.47)	0.000

Abbreviations: GCS, Glasgow Coma Scale; IVT, intraventricular; MRS, Modified Rankin Scale; CSF, cerebrospinal fluid.

Table 5 Outcomes and Complications

Variables	N (%)
Clinical cure	23/28 (82.1)
Etiological validity	26/28 (92.9)
Time from application of polymyxin B to negative CSF culture (mean ± SD) (range), days	8.23±4.02 (3–16)
Death	5/28 (17.6)
SVH	2/28 (7.1)
Extensive brain parenchymal infection	2/28 (7.1)
Massive secondary cerebral infarction	1/28 (3.6)
Complications
Hydrocephalus	18/28 (55.9)
VPS	18/28 (55.9)
Time from negative CSF cultures to VPS (Median)(IQR), days	82.5 (59.5,114.75)
Epilepsy	0/28 (0.0)

Abbreviations: SVH, spontaneous ventricular hemorrhage; VPS, ventriculoperitoneal shunt; CSF, cerebrospinal fluid.