-
Categories
-
Pharmaceutical Intermediates
-
Active Pharmaceutical Ingredients
-
Food Additives
- Industrial Coatings
- Agrochemicals
- Dyes and Pigments
- Surfactant
- Flavors and Fragrances
- Chemical Reagents
- Catalyst and Auxiliary
- Natural Products
- Inorganic Chemistry
-
Organic Chemistry
-
Biochemical Engineering
- Analytical Chemistry
-
Cosmetic Ingredient
- Water Treatment Chemical
-
Pharmaceutical Intermediates
Promotion
ECHEMI Mall
Wholesale
Weekly Price
Exhibition
News
-
Trade Service
Neurosurgery Central Nervous System Infections (NCNSIs) refer to intracranial and spinal canal infections secondary to neurosurgical diseases or that require neurosurgery treatment, including post-neurosurgical epidural abscess, subdural empyema, and meninges Inflammation, ventriculitis and brain abscess, intracranial infection caused by head trauma, external drainage of the ventricle and lumbar cistern, shunt and implant-related meningitis or ventriculitis, etc.
Among them, bacterial infection is the main type of CNSIs.
The early diagnosis of NCNSIs is difficult.
In order to determine standardized clinical pathways and standards for the diagnosis of CNSIs and improve the early diagnosis rate, domestic experts in the field have formed an expert consensus on the diagnosis and treatment of NCNSIs for reference.
The epidemiology of CNSIs and common pathogens The infection rate of CNSIs after neurosurgery is 4.
6% to 25%, accounting for 0.
8% to 7% of CNSIs.
According to different types of surgery, the incidence of postoperative meningitis is 1.
5% to 8.
6%, the incidence of ventricular drainage-related infections is 8% to 22%, and the incidence of CNSIs caused by craniocerebral trauma and external lumbar drainage are respectively.
It is 1.
4% and 5%.
The mortality of meningitis and (or) ventriculitis after neurosurgery is 3% to 33%.
Common pathogens of CNSIs include gram-negative bacteria, gram-positive bacteria and fungi, the former two are the main ones.
Anaerobic bacteria are common pathogens of brain abscess.
Clinical symptoms and signs of CNSIs The clinical symptoms include symptoms of systemic infection, symptoms of increased intracranial pressure, changes in consciousness and mental status, and symptoms of epilepsy and hypothalamic pituitary function reduction in some patients.
Typical signs include meningeal irritation and signs of infection after shunt.
Recommendations: ➤For patients after neurosurgery, CNSIs should be considered (low grade, weak recommendation) if they have fever, decreased consciousness, and systemic infections, and excluding infections outside the nervous system.
➤Ventricle or lumbar large cistern-abdominal cavity shunt patients with subcutaneous redness, swelling, tenderness of the shunt tube, and unexplained peritonitis symptoms and signs are highly suspected of shunt-related infections (medium level, strong recommendation).
Imaging manifestations of CNSIs CNSIs have different imaging manifestations based on the site of infection and stage.
Meningitis patients have no obvious conventional CT findings.
Some patients can see enhanced signals of the meninges and cerebral cortex after enhancement, but no enhancement can not rule out the diagnosis; early changes of MRI in patients with encephalitis are more sensitive than CT, so MRI should be considered first to assist diagnosis .
In patients with brain abscesses, enhanced MRI is the most sensitive examination for finding and locating brain abscesses.
Enhanced CT can show the typical circular enhanced lesions and low-density abscesses of abscesses.
MRI Diffusion Weighted Imaging (DWI) and Apparent Diffusion Coefficient (ADC) are of great significance in distinguishing the capsular phase of brain abscess from intracranial tumor necrosis cyst: brain abscess appears as high signal on DWI, and ADC shows low signal; and Intracranial tumor necrosis cystic area showed low signal on DWI, and high signal on ADC.
Recommendations: ➤ For patients with high suspicion of intracranial infection, CT or MRI is recommended to assist in diagnosis and treatment (medium level, strong recommendation).
➤It is recommended to use enhanced MRI and DWI sequences to assist in the differential diagnosis of brain abscesses (medium level, strong recommendation).
➤For the following patients with high suspicion of intracranial infection, head CT examination should be performed before lumbar puncture to assess the risk of brain herniation: new neurological deficit symptoms (except cranial nerve palsy) during the peak period of edema, new epilepsy, and increased consciousness disturbance Etc.
(Medium level, strong recommendation).
➤If the patient has symptoms of unexplained peritonitis after ventricular-abdominal shunt, abdominal ultrasound and CT can be used to assist in the diagnosis of the abdominal end of the shunt (medium level, strongly recommended).
Recommendations for CNSIs treatment ➤For empirical antibacterial therapy, we recommend vancomycin combined with anti-pseudomonas cephalosporins or carbapenems (high grade, strong recommendation).
➤For those with normal renal function using vancomycin, it is recommended to monitor the trough blood concentration after the first administration 48h (for those with renal insufficiency, 72h after the first administration), so that the trough concentration should be maintained at 15-20ug/ml (high grade, Strongly recommended).
➤Infections caused by methicillin-sensitive Staphylococcus aureus are recommended to be treated with oxacillin or ampicillin (medium level, strong recommendation).
➤For infections caused by methicillin-resistant Staphylococcus aureus, vancomycin or linezolid is recommended (medium level, strong recommendation).
➤The third and fourth generation cephalosporins, aztreonam, meropenem, sulfonamides, quinolones, vancomycin and rifampin have higher concentrations in the cerebrospinal fluid.
The above drugs can be selected according to the sensitivity of pathogenic bacteria (high Grade, strongly recommended).
➤For the infection caused by neurosurgical implants, the anti-infective treatment is ineffective, and the implants need to be removed (high grade, highly recommended).
➤Brain abscess diameter> 2cm, there are space-occupying effects such as intracranial hypertension or even brain herniation, surgical intervention is recommended (high grade, strong recommendation).
CNSIs diagnosis and treatment process CNSIs diagnosis and treatment process is shown in the figure below.
Yimaitong is compiled from: The Neurosurgery Critical Care Expert Committee of the Neurosurgery Branch of the Chinese Medical Doctor Association, and the Neurosurgery Critical Care Group of the Neurosurgery Branch of the Beijing Medical Association.
The Chinese Expert Consensus on the Diagnosis and Treatment of Central Nervous System Infections in Neurosurgery (2021 Edition)[J].
Chinese Journal of Neurosurgery, 2021, 37(1): 2-15.
Among them, bacterial infection is the main type of CNSIs.
The early diagnosis of NCNSIs is difficult.
In order to determine standardized clinical pathways and standards for the diagnosis of CNSIs and improve the early diagnosis rate, domestic experts in the field have formed an expert consensus on the diagnosis and treatment of NCNSIs for reference.
The epidemiology of CNSIs and common pathogens The infection rate of CNSIs after neurosurgery is 4.
6% to 25%, accounting for 0.
8% to 7% of CNSIs.
According to different types of surgery, the incidence of postoperative meningitis is 1.
5% to 8.
6%, the incidence of ventricular drainage-related infections is 8% to 22%, and the incidence of CNSIs caused by craniocerebral trauma and external lumbar drainage are respectively.
It is 1.
4% and 5%.
The mortality of meningitis and (or) ventriculitis after neurosurgery is 3% to 33%.
Common pathogens of CNSIs include gram-negative bacteria, gram-positive bacteria and fungi, the former two are the main ones.
Anaerobic bacteria are common pathogens of brain abscess.
Clinical symptoms and signs of CNSIs The clinical symptoms include symptoms of systemic infection, symptoms of increased intracranial pressure, changes in consciousness and mental status, and symptoms of epilepsy and hypothalamic pituitary function reduction in some patients.
Typical signs include meningeal irritation and signs of infection after shunt.
Recommendations: ➤For patients after neurosurgery, CNSIs should be considered (low grade, weak recommendation) if they have fever, decreased consciousness, and systemic infections, and excluding infections outside the nervous system.
➤Ventricle or lumbar large cistern-abdominal cavity shunt patients with subcutaneous redness, swelling, tenderness of the shunt tube, and unexplained peritonitis symptoms and signs are highly suspected of shunt-related infections (medium level, strong recommendation).
Imaging manifestations of CNSIs CNSIs have different imaging manifestations based on the site of infection and stage.
Meningitis patients have no obvious conventional CT findings.
Some patients can see enhanced signals of the meninges and cerebral cortex after enhancement, but no enhancement can not rule out the diagnosis; early changes of MRI in patients with encephalitis are more sensitive than CT, so MRI should be considered first to assist diagnosis .
In patients with brain abscesses, enhanced MRI is the most sensitive examination for finding and locating brain abscesses.
Enhanced CT can show the typical circular enhanced lesions and low-density abscesses of abscesses.
MRI Diffusion Weighted Imaging (DWI) and Apparent Diffusion Coefficient (ADC) are of great significance in distinguishing the capsular phase of brain abscess from intracranial tumor necrosis cyst: brain abscess appears as high signal on DWI, and ADC shows low signal; and Intracranial tumor necrosis cystic area showed low signal on DWI, and high signal on ADC.
Recommendations: ➤ For patients with high suspicion of intracranial infection, CT or MRI is recommended to assist in diagnosis and treatment (medium level, strong recommendation).
➤It is recommended to use enhanced MRI and DWI sequences to assist in the differential diagnosis of brain abscesses (medium level, strong recommendation).
➤For the following patients with high suspicion of intracranial infection, head CT examination should be performed before lumbar puncture to assess the risk of brain herniation: new neurological deficit symptoms (except cranial nerve palsy) during the peak period of edema, new epilepsy, and increased consciousness disturbance Etc.
(Medium level, strong recommendation).
➤If the patient has symptoms of unexplained peritonitis after ventricular-abdominal shunt, abdominal ultrasound and CT can be used to assist in the diagnosis of the abdominal end of the shunt (medium level, strongly recommended).
Recommendations for CNSIs treatment ➤For empirical antibacterial therapy, we recommend vancomycin combined with anti-pseudomonas cephalosporins or carbapenems (high grade, strong recommendation).
➤For those with normal renal function using vancomycin, it is recommended to monitor the trough blood concentration after the first administration 48h (for those with renal insufficiency, 72h after the first administration), so that the trough concentration should be maintained at 15-20ug/ml (high grade, Strongly recommended).
➤Infections caused by methicillin-sensitive Staphylococcus aureus are recommended to be treated with oxacillin or ampicillin (medium level, strong recommendation).
➤For infections caused by methicillin-resistant Staphylococcus aureus, vancomycin or linezolid is recommended (medium level, strong recommendation).
➤The third and fourth generation cephalosporins, aztreonam, meropenem, sulfonamides, quinolones, vancomycin and rifampin have higher concentrations in the cerebrospinal fluid.
The above drugs can be selected according to the sensitivity of pathogenic bacteria (high Grade, strongly recommended).
➤For the infection caused by neurosurgical implants, the anti-infective treatment is ineffective, and the implants need to be removed (high grade, highly recommended).
➤Brain abscess diameter> 2cm, there are space-occupying effects such as intracranial hypertension or even brain herniation, surgical intervention is recommended (high grade, strong recommendation).
CNSIs diagnosis and treatment process CNSIs diagnosis and treatment process is shown in the figure below.
Yimaitong is compiled from: The Neurosurgery Critical Care Expert Committee of the Neurosurgery Branch of the Chinese Medical Doctor Association, and the Neurosurgery Critical Care Group of the Neurosurgery Branch of the Beijing Medical Association.
The Chinese Expert Consensus on the Diagnosis and Treatment of Central Nervous System Infections in Neurosurgery (2021 Edition)[J].
Chinese Journal of Neurosurgery, 2021, 37(1): 2-15.
