Combination of Conventional EVD and Ommaya Drainage for Intraventricular Hemorrhage (IVH).

Background: The effect of Ommaya reservoirs on the clinical outcomes of patients with intraventricular hemorrhage (IVH) remains unclear. Objective: We aimed to determine the effect of combining the Ommaya reservoir and external ventricular drainage (EVD) therapy on IVH and explore better clinical indicators for Ommaya implantation. Methods: A retrospective analysis was conducted on patients diagnosed with IVH who received EVD-Ommaya drainage between January 2013 and March 2021. The patient population was divided into two groups: the Ommaya-used group, comprising patients in whom the Ommaya drainage system was activated post-surgery, and the Ommaya-unused group, comprising patients in whom the system was not activated. The study analyzed clinical, imaging, and outcome data of the patient population. Results: A total of 123 patients with IVH were included: 75 patients in the Ommaya-used group and 48 patients in the Ommaya-unused group. The patients in the Ommaya-used group showed a lower 3-month GOS than those in the Ommaya-unused group (p<0.0001). The modified Graeb scale (mGS) in the Ommaya-unused group was significantly lower than that in the Ommaya-used group before the operation (p<0.01) but not after surgery (p>0.05). The GCS in the Ommaya-unused group was significantly lower than that in the other group, and there was a close correlation between the GCS and 3-month GOS (p<0.0001). The GCS score showed significance in predicting the use of Ommaya (p<0.001). Conclusion: The study demonstrated that combining EVD and Ommaya drainage was a safe and feasible treatment for IVH. Additionally, preoperative GCS was found to predict the use of Ommaya drainage in subsequent treatment, providing valuable information for pre-surgery decision-making.

Early Intraventricular Antibiotic Therapy Improved In-Hospital-Mortality in Neurocritical Patients with Multidrug-Resistant Bacterial Nosocomial Meningitis and Ventriculitis.

BACKGROUND: Hospital-acquired multidrug-resistant (MDR) bacterial meningitis and/or ventriculitis (MEN) is a severe condition associated with high mortality. The risk factors related to in-hospital mortality of patients with MDR bacterial MEN are unknown. We aimed to examine factors related to in-hospital mortality and evaluate their prognostic value in patients with MDR bacterial MEN treated in the neurointensive care unit. METHODS: This was a single-center retrospective cohort study of critically ill neurosurgical patients with MDR bacterial MEN admitted to our hospital between January 2003 and March 2021. Data on demographics, admission variables, treatment, time to start of intraventricular (IVT) therapy, and in-hospital mortality were analyzed. Both univariate and multivariable analyses were performed to identify determinants of in-hospital mortality. RESULTS: All 142 included patients received systemic antibiotic therapy, and 102 of them received concomitant IVT treatment. The median time to start of IVT treatment was 2 days (interquartile range 1-5 days). The time to start of IVT treatment had an effect on in-hospital mortality (hazard ratio 1.17; 95% confidence interval 1.02-1.34; adjusted p = 0.030). The cutoff time to initiate IVT treatment was identified at 3 days: patients treated within 3 days had a higher cerebrospinal fluid (CSF) sterilization rate (81.5%) and a shorter median time to CSF sterilization (7 days) compared with patients who received delayed IVT treatment (> 3 days) (48.6% and 11.5 days, respectively) and those who received intravenous antibiotics alone (42.5% and 10 days, respectively). CONCLUSIONS: Early IVT antibiotics were associated with superior outcomes in terms of the in-hospital mortality rate, time to CSF sterilization, and CSF sterilization rate compared with delayed IVT antibiotics and intravenous antibiotics alone.

Prevalence and Clinical Characteristics of Bacterial Pneumonia in Neurosurgical Emergency Center Patients: A Retrospective Study Spanning 13 Years at a Tertiary Center.

Patients with brain injuries are at a heightened susceptibility to bacterial pneumonia, and the timely initiation of empiric antibiotic treatment has been shown to substantially reduce mortality rates. Nevertheless, there is a need for knowledge regarding the resistance and prevalence of pulmonary bacterial infections in this patient population. To address this gap, a retrospective study was conducted at a neurosurgical emergency center, focusing on patients with brain injuries. Among the entire patient population, a total of 739 individuals (18.23%) were identified as having bacterial pneumonia, consisting of 1489 strains of Gram-negative bacteria and 205 strains of Gram-positive bacteria. The resistance of Klebsiella pneumoniae to imipenem exhibited a significant increase, rising from 21.74% in 2009 to 96.67% in 2018, and subsequently reaching 48.47% in 2021. Acinetobacter baumannii displayed resistance rates exceeding 80.0% against multiple antibiotics. The resistance profile of Pseudomonas aeruginosa was relatively low. The proportion of Staphylococcus aureus reached its peak at 18.70% in 2016, but experienced a decline to 7.83% in 2021. The abundance of Gram-negative bacteria exceeded that of Gram-positive bacteria by a factor of 5.96. Klebsiella pneumoniae, Acinetobacter baumannii, and Staphylococcus aureus are prominent pathogens characterized by limited antibiotic choices and scarce treatment alternatives for the isolated strains.

Apelin-Overexpressing Neural Stem Cells in Conjunction with a Silk Fibroin Nanofiber Scaffold for the Treatment of Traumatic Brain Injury.

Traumatic brain injury (TBI), especially moderate or severe TBI, is one of the most devastating injuries to the nervous system, as the existing therapies for neurological defect repair have difficulty achieving satisfactory results. Neural stem cells (NSCs) therapy is a potentially effective treatment option, especially after specific genetic modifications and when used in combination with biomimetic biological scaffolds. In this study, tussah silk fibroin (TSF) scaffolds with interconnected nanofibrous structures were fabricated using a top-down method. We constructed the apelin-overexpressing NSCs that were cocultured with a TSF nanofiber scaffold (TSFNS) that simulated the extracellular matrix in vitro. To verify the therapeutic efficacy of engineered NSCs in vivo, we constructed TBI models and randomized the C57BL/6 mice into three groups: a control group, an NSC-ctrl group (transplantation of NSCs integrated on TSFNS), and an NSC-apelin group (transplantation of apelin-overexpressing NSCs integrated on TSFNS). The neurological functions of the model mice were evaluated in stages. Specimens were obtained 24 days after transplantation for immunohistochemistry, immunofluorescence, and western blot experiments, and statistical analysis was performed. The results showed that the combination of the TSFNS and apelin overexpression guided extension and elevated the proliferation and differentiation of NSCs both in vivo and in vitro. Moreover, the transplantation of TSFNS-NSCs-Apelin reduced lesion volume, enhanced angiogenesis, inhibited neuronal apoptosis, reduced blood-brain barrier damage, and mitigated neuroinflammation. In summary, TSFNS-NSC-Apelin therapy could build a microenvironment that is more conducive to neural repair to promote the recovery of injured neurological function.

Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry for the identification of beta-hemolytic streptococci.

OBJECTIVE: Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) has emerged as promising technology for species identification. The purpose of this investigation was to compare the performance of MS and the traditional method for identification of beta-hemolytic streptococci (BHS). METHODS: Clinical BHS isolates were identified by the BD Phoenix SMIC/ID Streptococcal panels, and two MALDI-TOF MS platforms: the VITEK MS and the Bruker MALDI Biotyper systems respectively. In case of discordant results, 16sRNA sequencing was performed to provide the reference ID. RESULTS: A total of 96 isolates of BHS were analyzed. Thirty-six isolates (20.8%) were re-tested by BD Phoenix for identification failure; and four isolates (4.2%) were rerun on the Bruker system for low identification score. No isolate need a second run for identification by Vitek MS system. Overall, BD Phoenix, BioTyper and Vitek MS automated system accurately identified 76 strains (79.2%), 91 (94.7%) strains and 92 (95.8%) strains, respectively. CONCLUSIONS: Our study suggests that MALDI-TOF MS is a superior method to conventional phenotypic methods for BHS identification.

Improvement in clinical and economic outcomes with empiric antibiotic therapy covering atypical pathogens for community-acquired pneumonia patients: a multicenter cohort study.

OBJECTIVE: To determine the effectiveness of empiric antibiotic regimens covering atypical pathogens with respect to detailed clinical and economic outcomes in community-acquired pneumonia (CAP). METHODS: A population-based, multicenter, retrospective cohort study was conducted from June 2010 to May 2011. Patients with a diagnosis of CAP were enrolled and categorized into two groups according to the initial antibiotic strategy used - covering or not covering atypical pathogens. Regression analysis was performed to assess their clinical outcomes (all-cause mortality, clinical improvement rate after 72 h of antimicrobial therapy, and clinical cure rate) and economic outcomes (length of stay, hospitalization costs, and antibiotic expenditure). RESULTS: A total of 827 patients met the criteria for CAP; 561 (67.8%) received antibiotics with atypical pathogen coverage (APC group), while 266 (32.2%) did not (non-APC group). Regression analysis revealed that the all-cause mortality was much lower in the APC group than in the non-APC group (0.9% vs. 4.9%, respectively), with an odds ratio (OR) of 0.18 (95% confidence interval (CI) 0.06-0.49). Clinical improvement at 72 h (87.7% vs. 85.0%, p=0.274) and the clinical cure rate (91.1% vs. 88.3%, p=0.213) were more favorable in the APC group, but with no significant difference compared to the non-APC group. Moreover, the APC group had a shorter mean length of stay (APC 10.2 days vs. non-APC 11.6 days, p<0.001). In addition, the mean total hospitalization costs for the APC group were markedly lower compared with the non-APC group (US$ 1172.7 vs. US$ 1510.7; p<0.001). CONCLUSION: Antimicrobial treatment covering atypical pathogens for hospitalized CAP patients is associated with reduced mortality and economic burden.

The value of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry in identifying clinically relevant bacteria: a comparison with automated microbiology system.

BACKGROUND: Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) has been developed as a new-type soft ionization mass spectrometry in the recent year. Increasing number of clinical microbiological laboratories consider it as an innovate approach for bacterial identification. METHODS: A total of 876 clinical strains, comprising 52 species in 27 genus, were obtained from Fudan University Affiliated Zhongshan Hospital. We compared the identification accuracy of the Vitek MS system (bioMerieux, Marcy l'Etoile) to other conventional methods for bacterial identification. 16S rRNA gene sequencing was performed as a reference identification method in cases of discrepant results. RESULTS: The Vitek MS system consistently produced accurate results within minutes of loading, while conventional methods required several hours to produce identification results. Among the 876 isolates, the overall performance of Vitek MS was significantly better than the conventional method both for correct species identification (830, 94.7% vs. 746, 85.2%, respectively, P=0.000). CONCLUSIONS: Compared to traditional identification methods, MALDI-TOF MS is a rapid, accurate and economical technique to enhance the clinical value of microorganism identification.

[Analysis of clinical characteristics and risk factors associated with prognosis of patients with candidemia].

OBJECTIVE: To explore the microbiological and clinical characteristics of patients with candidemia and analyze their prognostic risk factors. METHODS: A retrospective analysis was conducted for hospitalized patients with candidemia from January 2008 to December 2012 at Affiliated Zhongshan Hospital, Fudan University. Pathogen spectrum, resistance pattern, underlying diseases, therapy received and patient prognosis were collected by chart review. The univariate and multivariate Logistic regression analyses were used to determine the prognostic risk factors of candidemia. RESULTS: A total of 138 inpatients were identified. There were 98 males and 40 females with a mean age of (61.3 ± 16.6) years. The morbidity rate of candidemia in annual discharged patients was 0.034%-0.051%. The most common pathogens were Candida albicans (n = 72, 52.2%), Candida parapsilosis (n = 29, 21.0%) and Candida tropicalis (n = 16, 11.6%). The antibiotic susceptible rate of azole for Candida was 90.9%-97.4% while 55.6%-83.3% for Candida tropicalis. The overall case fatality rate of candidemia was 39.1% (54/138) while the attributable case fatality rate 31.9% (44/138). Multivariate Logistic regression analysis indicated acute physiology and chronic health evaluation II(APACHE II) score ≥ 20 points (OR = 8.025, 95%CI: 2.032-31.696, P = 0.003), hypoproteinemia (OR = 6.213, 95%CI: 1.849-20.879, P = 0.003), concurrent bacteremia (OR = 5.541, 95%CI: 1.576-19.487, P = 0.008) and indwelling urethral catheter (OR = 13.776, 95%CI: 1.402-135.352, P = 0.024) were the independent risk factors of candidemia-related mortality, while removal or replacement of central venous catheter (OR = 0.231, 59%CI: 0.075-0.716, P = 0.011) and surgery within 30 days (OR = 0.206, 95%CI: 0.050-0.857, P = 0.030) were the protective factors. CONCLUSIONS: Candida albicans is the most common causative agent. The case fatality rate of candidemia has remained high. APACHE II score ≥ 20 points, hypoproteinemia, indwelling urethral catheter and concurrent bacteremia are independent risk factors attributing to candidemia-related mortality while removal or replacement of central venous catheter and surgery within 30 days are the protective ones.