Prevalence and antibiotic resistance of bacteria isolated from the cerebrospinal fluid of neurosurgical patients at Peking Union Medical College Hospital

Jian-Bo Chang,Bai-Tao Ma,Ren-Zhi Wang,Jun-Ji Wei,He Wang,Hao Wu

doi:10.1186/s13756-018-0323-3

Abstract

BackgroundPostoperative central nervous system infections (PCNSIs) represent a serious complication, and the timely use of antibiotics guided by the identification of the causative pathogens and their antibiotic sensitivities is essential for treatment. However, there are little data regarding the prevalence of PCNSI pathogens in China. The aim of this study is to investigate the features of pathogens in patients with PCNSIs, which could help clinicians to choose the appropriate empirical antibiotic therapy.MethodsWe retrospectively examined the positive CSF cultures in patients who underwent craniotomy between January 2010 and December 2015. We collected data, including demographic characteristics, type of neurosurgery, laboratory data, causative organisms and antimicrobial susceptibility testing results.ResultsA total of 62 patients with 90 isolates out of 818 patients with 2433 CSF culture samples were available for data analysis. The estimated incidence and culture-positive rate of PCNSIs were approximately 0.9 and 7.5%, respectively. The predominant organism was coagulase-negative staphylococci, of which most were methicillin-resistant coagulase-negative staphylococci (MRCoNS). All were susceptible to vancomycin, linezolid, rifampicin and amoxicillin-clavulanate. Acinetobacter baumannii was the most frequent causative Gram-negative agent and was resistant to 12 out of 18 antimicrobials tested. The sensitivity rates for tigecycline and minocycline were only 40 and 33%, respectively.ConclusionPCNSIs could lead to high mortality. Although the MRCoNS were the predominant organism, the management of Acinetobacter baumannii was a major clinical challenge with few effective antimicrobials in PCNSIs.

Highlights

Postoperative central nervous system infections (PCNSIs) represent a serious complication, and the timely use of antibiotics guided by the identification of the causative pathogens and their antibiotic sensitivities is essential for treatment
The primary pathogens in PCNSI are still Gram-positive bacteria, such as Staphylococcus aureus, there is a possible trend towards greater numbers of Gramnegative bacteria, especially Acinetobacter [5, 6]
The incidence of PCNSIs was approximately 0.9% (62/6500) and the estimated culture-positive rate of infection was approximately 7.5% (62/818) and 16 patients with 44 isolates were infected with polymicrobial, in which six patients with more than two species

Summary

Introduction

Postoperative central nervous system infections (PCNSIs) represent a serious complication, and the timely use of antibiotics guided by the identification of the causative pathogens and their antibiotic sensitivities is essential for treatment. Postoperative central nervous system infections (PCNSIs) are relatively rare but serious complication following neurosurgery, especially craniotomies, resulting in poor patient outcomes and increasing the total cost of illness. The primary pathogens in PCNSI are still Gram-positive bacteria, such as Staphylococcus aureus, there is a possible trend towards greater numbers of Gramnegative bacteria, especially Acinetobacter [5, 6]. Another obvious change is the increased rates of multi-antibiotic. The potential underlying cause is the widespread use of empirical vancomycin and antipseudomonal β-lactam antibiotics [8]

Objectives

Methods

Results

Discussion

Conclusion