Title Infekcije povezane sa sustavima za trajnu odvodnju cerebrospinalnog likvora Title (english) Infections associated with permanent CSF drainage systems Author Jelena Prepolec Mentor Goran Tešović (mentor)Committee member Dalibor Vukelić (predsjednik povjerenstva)Committee member Josip Begovac (član povjerenstva)Committee member Goran Tešović (član povjerenstva)Granter University of Zagreb Defense date and country 2019-07-12, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Sustavi za trajnu odvodnju likvora postavljaju se kao dio terapije hidrocefalusa, najčešće kongenitalne, posthemoragijske ili postoperativne etiologije. Kao sustav za trajnu odvodnju likvora većinom se koristi ventrikulo-peritonejska drenaža (VPD) koja je rizični čimbenik za razvoj shunt meningitisa. Cilj ovog retrospektivnog deskriptivnog istraživanje provedenog u Klinici za infektivne bolesti „dr. Fran Mihaljević“ bio je analizirati demografske i kliničke karakteristike bolesnika dječje i adolescentne dobi oboljelih od shunt meningitisa u razdoblju od početka 2004. do kraja 2018. godine. U istraživanje je bilo uključeno 47 bolesnika koji su se prezentirali sa 68 slučajeva shunt meningitisa. Medijan dobi iznosio je 1,1 godinu. Najčešća dijagnoza bio je akutni bakterijski meningitis (ABM), dijagnosticiran u 81 % slučajeva, dok je u 13 % bolesnika dijagnosticiran eozinofilni meningitis (EM) kao reakcija na strano tijelo. U bolesnika s dijagnozom ABM-a uzročnik je izoliran iz likvora u 80 % slučajeva pri čemu je Staphylococcus epidermidis izoliran u 61 % bolesnika. Simptomi meningitisa razvili su se unutar 30 dana od postavljanja VPD-a u 49 % slučajeva ABM-a i 67 % slučajeva EM-a. Razlika u vremenima lantencije bila je statistički značajno niža u skupine bolesnika s dijagnozom EM-a pri čemu je medijan iznosio 3,5 dana, a za ABM 27 dana. Kao komplikacija ABM-a u 28 % bolesnika razvio se peritonitis na koji je upućivala statistički značajno povišena vrijednost CRP-a. Medijan vremena sterilizacije u bolesnika s kongenitalnim hidrocefalusom bio je statistički značajno niži te je iznosio 8 dana, dok je u ostalih bolesnika iznosio 16 dana. U bolesnika s dijagnozom ABM-a bio je jasan nalaz povišenih vrijednosti specifičnih za bakterijsku upalu (CRP, leukociti u krvi, udio neutrofila u krvi) kao i jasan nalaz likvora specifičan za ABM (pleocitoza, povišen udio polimononukleara te nalaz hipoglikorahije). U bolesnika s dijagnozom ABM-a uzrokovanim uzročnikom iz skupine „G -“ udjeli neutrofila u krvi i polimorfonukleara u likvoru bili su statistički značajno viši nego u skupini bolesnika s ABM-om uzrokovanim uzročnicima iz skupine „G +“. Bolesnici s ABM-om liječeni su ili konzervativno, samo primjenom antibiotika, ili u kombinaciji sa zamjenom sustava za odvodnju likvora. Vankomicin (87 %) i meropenem (72 %) bili su najčešće korišteni antibiotici u liječenju bolesnika s ABM-om. Svi bolesnici s EM-om liječeni su primjenom kortikosteroida. U 3 bolesnika (6,4 %) bolest je rezultirala smrtnim ishodom. ABM najčešći je oblik shunt meningitisa te se uglavnom javlja unutar 30 dana od postavljanja VPD-a s kliničkom slikom bakterijske upale. Stoga je važno pravovremeno dijagnosticirati i liječiti bolesnike kako bi se spriječio razvoj komplikacija i smrtnog ishoda.
Abstract (english) Permanent cerebrospinal fluid (CSF) drainage systems are used as part of hydrocephalus therapy, most commonly of congenital, post-hemorrhagic or postoperative etiology. Ventriculoperitoneal shunt (VPS) is the main system for permanent drainage of CSF, which is a risk factor for the development of shunt meningitis. The aim of this retrospective descriptive research conducted at the Hospital for Infectious Diseases "dr. Fran Mihaljević " was to analyze the demographic and clinical characteristics of pediatric patients with shunt meningitis in the period 2004 - 2018. This study analysed 47 patients who presented with 68 episodes of meningitis. Median age was 1.1 years. The most common diagnosis was acute bacterial meningitis (ABM), diagnosed in 81% of cases, while eosinophilic meningitis (EM) as a reaction to a foreign body occured in 13% of patients. In subjects with ABM, the ethiology was confirmed by isolation from the CSF in 80% of cases. 61% of patients were positive for Staphylococcus epidermidis. Symptoms developed within 30 days of VPS implantation in 49% of ABM cases and in 67% of EM cases. The difference in latency was statistically significantly lower in EM patients (median of 3.5 days) than in ABM patients (median of 27 days). In 28% of patients ABM was complicated by peritonitis indicated by statistically significantly elevated CRP. Median time of sterilization in patients with congenital hydrocephalus was 8 days which was statistically significantly lower than in other patients (16 days). In patients with ABM diagnosis there was a clear finding of elevated values specific for bacterial inflammation (CRP, blood leukocytes, neutrophil blood counts) as well as a clear finding of ABM-specific CSF findings (pleocytosis, elevated fraction of polymononuclears and hypoglycorrhachia). In patients diagnosed with ABM caused by the "G-" group, blood neutrophil counts and CSF polymorphonuclear counts were statistically significantly higher than in the group of patients with ABM caused by "G+". ABM patients were treated either conservatively, using only antibiotics, or in combination with the replacement of the drainage system. Vancomycin (87%) and meropenem (72%) were the most common antibiotics in the treatment of patients with ABM. All patients with EM were treated with corticosteroids. Three patients (6,4%) died. ABM is the most common form of shunt meningitis and it usually occurs within 30 days of VPS implantation with a clinical presentation of bacterial inflammation. It is therefore important to diagnose and treat patients in a timely manner in order to prevent the development of complications and deaths.
Keywords
shunt meningitis
akutni bakterijski meningitis
hidrocefalus
Keywords (english)
shunt meningitis
acute purulent meningitis
hydrocephalus
Language croatian URN:NBN urn:nbn:hr:105:096468 Study programme Title: Medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2019-11-22 13:23:56
