RESUMO
"Healthcare-associated ventriculitis and meningitis" is a potentially devastating illness following neurosurgical procedures. Multidrug resistant (MDR) and extensively drug resistant (XDR) organisms such as Acinetobacter baumannii and Klebsiella pneumoniae have increasingly been isolated in ventriculitis and meningitis episodes. The treatment of these infections can be challenging, as the antimicrobial options are restricted. Regarding Central Nervous System (CNS) infections the transfer of the antibiotics to the Cerebrospinal Fluid (CSF) is often low which results in decreased drug levels at the infection site. The intraventricular (IVT) administration of antibiotics can be used as an adjunct to the intravenous (IV) treatment of Gram-negative MDR ventriculitis and meningitis, yet pertinent data is scarce. We present the successful management of three cases of healthcare-associated ventriculitis and meningitis due to XDR species with the combined intraventricular administration of colistin and off-label tigecycline, after the initial regimen of colistin given alone through both IVT and IV routes had failed.
Assuntos
Infecções por Acinetobacter/tratamento farmacológico , Ventriculite Cerebral/tratamento farmacológico , Colistina/administração & dosagem , Injeções Intraventriculares , Infecções por Klebsiella/tratamento farmacológico , Tigeciclina/administração & dosagem , Acinetobacter baumannii/efeitos dos fármacos , Administração Intravenosa , Antibacterianos/uso terapêutico , Sistema Nervoso Central/efeitos dos fármacos , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Quimioterapia Combinada , Encefalite , Feminino , Humanos , Infusões Intraventriculares , Klebsiella pneumoniae/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Projetos de Pesquisa , Adulto JovemRESUMO
Erectile dysfunction (ED) has been previously reported in patients with cervical spondylotic myelopathy. After treatment, patients usually experience an improvement in sexual function. Herewith, we present a patient with cervical disc herniation at the C3-C4 and C5-C6 level with ED but without myelopathy. The patient underwent anterior microdiscectomy and fusion with cages. ED improved postoperatively. We propose that the presence of ED should be checked in patients with cervical disc herniation. Further studies are needed to clarify the incidence of ED in patients with cervical disc herniation.