RESUMEN
Acinetobacter baumannii has emerged as an important nosocomial pathogen that can cause a multitude of severe infections. In neurosurgical patients the usual presentation is ventriculitis associated with external ventricular drainage. Carbapenems have been considered the gold standard for the treatment of Acinetobacter baumannii ventriculitis, but resistant isolates are increasing worldwide, reducing the therapeutic options. In many cases polymyxins are the only possible alternative, but their poor blood-brain barrier penetration could require them to be directly administered intraventricularly and clinical experience with this route is limited. We review the literature concerning intraventricular use of colistin (polymyxin E) for A. baumannii ventriculitis and add three cases successfully treated with this method. Our experience suggests that intraventricular colistin is a potentially effective and safe therapy for the treatment of multidrug-resistant A. baumannii central nervous system infections.
Asunto(s)
Infecciones por Acinetobacter/tratamiento farmacológico , Acinetobacter baumannii/efectos de los fármacos , Colistina/administración & dosificación , Encefalitis/tratamiento farmacológico , Ventrículos Laterales/cirugía , Infecciones por Acinetobacter/patología , Infecciones por Acinetobacter/fisiopatología , Acinetobacter baumannii/fisiología , Adulto , Antibacterianos/administración & dosificación , Encéfalo/diagnóstico por imagen , Encéfalo/microbiología , Encéfalo/patología , Derivaciones del Líquido Cefalorraquídeo , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/prevención & control , Resistencia a Múltiples Medicamentos , Encefalitis/microbiología , Encefalitis/fisiopatología , Resultado Fatal , Femenino , Humanos , Hidrocefalia/diagnóstico por imagen , Hidrocefalia/microbiología , Hidrocefalia/cirugía , Inyecciones Intraventriculares/métodos , Ventrículos Laterales/diagnóstico por imagen , Ventrículos Laterales/microbiología , Masculino , Meningitis Bacterianas/complicaciones , Meningitis Bacterianas/tratamiento farmacológico , Meningitis Bacterianas/microbiología , Persona de Mediana Edad , Hemorragia Subaracnoidea/diagnóstico por imagen , Hemorragia Subaracnoidea/microbiología , Hemorragia Subaracnoidea/patología , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Ventriculostomía/métodosRESUMEN
Cervical spondylotic myelopathy is the most severe consequence of degenerative disease of cervical spine. In this article we perform a bibliographic review, addressing current controversies in its pathophysiology. Present work lines of most groups dedicated to the study of this condition are focused on improving surgical techniques designed for the treatment of this disease. Pathophysiological studies are scarce, and most of our pathophysiological knowledge of cervical spondylotic myelopathy is based in works done in 60s and 70s. Literature of the last decade lacks neurochemichal studies parallel to those existing for acute spinal injury. In the same way, only three prospective clinical trials comparing conservative and surgical treatment have been done, and none of them has demonstrated clear superiority of surgery. Given the high prevalence of this disease, the need for deep knowledge of its pathophysiologic, neurochemichal and molecular basis, and the optimization of surgical treatment is justified. This probably implies the need for prospective randomized trials to determine which patients are going to benefit from surgery.