신경외과 수술 후 감염: 뇌실염 및 뇌막염을 중심으로
Infectious Complications after Neurosurgery: Mainly Focusing on Ventriculitis and Meningitis
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초록
Ventriculitis and nosocomial meningitis are major infectious complications after neurosurgery. Determining whether fever after neurosurgery is infectious origin or not should be meticulously performed. Cell index >5 could be a reliable parameter for the decision to empirical treatment before microbiological documentation. Antimicrobials should be prudently chosen on the basis of risk factors (craniotomy,ventricular catheterization, trauma such as basal skull fracture) and of the pharmacokinetic properties along with blood-brain-barrier (BBB) permeability. Antimicrobials which have poor permeability to the BBB, glycopeptide as an example, could be administered via intrathecal route. If microbiological documentation is obtained after empirical treatment, the regimen should be adjusted according to the result of culture and sensitivity.
Abstract
Ventriculitis and nosocomial meningitis are major infectious complications after neurosurgery. Determining whether fever after neurosurgery is infectious origin or not should be meticulously performed. Cell index >5 could be a reliable parameter for the decision to empirical treatment before microbiological documentation. Antimicrobials should be prudently chosen on the basis of risk factors (craniotomy,ventricular catheterization, trauma such as basal skull fracture) and of the pharmacokinetic properties along with blood-brain-barrier (BBB) permeability. Antimicrobials which have poor permeability to the BBB, glycopeptide as an example, could be administered via intrathecal route. If microbiological documentation is obtained after empirical treatment, the regimen should be adjusted according to the result of culture and sensitivity.
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