Efficacy and safety of different antimicrobial agents in the treatment of postoperative infections of central nervous system

OBJECTIVE To evaluate the efficacy and safety of three antimicrobial regimens including vancomycin combined with β-lactam antibiotics against pseudomonas（group A）, piperacillin tazobactam/sulbactam（group B） and ceftriaxone（group C） in the patients with postoperative central nervous system infections（CNSIs）, so as to provide reference for the rational use of antimicrobial agents for different degrees of CNSIs. METHODS From Jun 2019 to Dec 2020, 49 patients with postoperative CNSIs in a grade A tertiary hospital were enrolled. The temperature, blood routine, cerebrospinal fluid, procalcitonin, microorganisms and other indexes of the three different anti-infection regimens before and after treatment were detected, and the occurrence of adverse reactions was monitored. RESULTS All 49 patients were treated effectively, and patients in the group A showed the highest effective rate of 43.33%. Body temperature and blood routine indexes among the three groups decreased after 7 days of treatment（P＜0.05）, but patients in the group A took the longest time to return to normal（below 37.3℃） temperature. After treatment, the WBC, multinucleated cells ratio and protein quantity in cerebrospinal fluid of the three groups were lower than before（P＜0.01）; the decrease of WBC in cerebrospinal fluid of group A was the greatest（P＜0.01）, and the glucose level was higher than that before treatment（P＜0.05）. A total of 16 adverse drug reactions were observed in the treatment groups, 14 of which occurred in the group A, mainly drug fever and leukopenia. CONCLUSION The optimal efficacy of vancomycin combined with anti-pseudomonas β-lactam antibiotics in the treatment of moderate and severe CNSIs is the best, but their safety is slightly poor. It is necessary to monitor plasma concentration of vancomycin and patients′ renal function. Piperacillin and ceftriaxone are effective and safe in the treatment of CNSIs, which can be optimal treatment for mild to moderate CNSIs and step-down therapy.