Multidrug-resistant Gram-negative post-neurosurgical meningitis and the role of intraventricular colistin: a case series.

The aim of this study was to report the clinical experience of intraventricular colistin for the treatment of multi-resistant Gram-negative post-surgical meningitis in a tertiary hospital. Post-neurosurgical meningitis (PNM) is one of the life-threatening complications of neurosurgical procedures, and is frequently sustained by Acinetobacter baumannii and Klebsiella pneumoniae. Here we describe our experience of five cases of PNM caused by gram-negative multi-drug resistant (MDR) bacteria, treated with intraventricular (IVT) colistin, admitted to the Neurosurgery Unit of A.R.N.A.S. Civico of Palermo, Italy, from January 2016 to June 2020. In four patients the cerebrospinal fluid (CSF) culture was positive for A. baumannii, while in one patient it was positive for K. pneumoniae. IVT colistin therapy was administered for a median time of 18 days (range 7-29). The median time to CSF negativization was seven days (range 5-29). IVT colistin administration was associated with intravenous administration of meropenem and colistin in all patients. As regards clinical outcome, four patients were successfully treated and were subsequently discharged, while one patient died following respiratory complications and subsequent brain death. IVT colistin administration is an effective therapy for MDR post-neurosurgical meningitis and its administration is also prescribed by guidelines. However, IVT therapy for Gram-negative ventriculitis is mostly understudied. Our paper adds evidence for such treatment that can actually be considered life-saving.

[Comparing two different techniques to assess the appropriateness of admissions provided in the emergency room of a pediatric hospital]. / Confronto fra due modalità di valutazionedell'appropriatezza dei ricoveri dispostidal pronto soccorso di un ospedale pediatrico.

Two different techniques aimed to assess the appropriateness of hospital utilisation were used to study the same sample of clinical records of admissions provided during 2001 by the emergency room of a pediatric sicilian hospital. The first technique estimated the '"high risk of inappropriateness" DRGs prevalence, according to the Decreto del Presidente del Consiglio dei Ministri of 29 Novembre 2001, and the second was the pediatric version of the Appropriateness Evaluation Protocol (AEP), based on clinical characteristics of patients and complexity of assistance provided. The comparison of results did not show any agreement between the two techniques (kappa= 0,031, C. I. 95%: from -0,001 to +0,062). In a paediatric emergency room AEP criteria cannot be used as clinical guidelines aimed to reduce the prevalence of "high risk of inappropriateness" DRGs.