Research purpose. To study etiological and pathogenetic features of brain abscesses based on clinical data and the results of bacteriological tests on own clinical experience. Methods and subjects. 242 cases of brain abscess were analyzed for patients from 6 regions of Ukraine. Adults (18-59 years old) prevailed 195 patient (80.6 %), elderly patients (60-74 years) were 15 (6.2 %) persons, children (0-18 years) were 32 (13.2 %). Results and discussions. In our research bacteriologic examination of content of abscesses was conducted in all cases. Bacterial growth was registered in 58 (24.9 %) cases. A Gram-positive flora prevailed in 44 cases, Gram-negative was in 14 cases. Hematic abscess was associated with Gram-positive flora in 9 from 12 cases, abscesses inducted by otolaryngologic illnesses occurred in 9 from 17 cases, posttraumatic abscess was observed in 9 cases from 11. At odontogenic abscess, according to literature data, causative agents are mainly ana-erobes which are not practically selected in our laboratories. At the analysis of fatal cases a death rate was 8.6 ± 3.7 % at the etiologically confirmed supervisions, and 13.04 ± 2.50 % in the absence of the selected causative agent. Conclusions. The basic factors while choosing antibiotics at brain abscess are antimicrobial activity in regard to dominant causative agent, bactericidal or bacteriostatic properties of preparation, and ability of antibiotics to penetrate through the brain-blood barrier.
Epidemiology is reflected, level of diagnostics, occupational risk of infecting of hepatitis B,C and human immunodeficiency of virus infection, recommendations for preventing are described.
Currently available data on the diagnosis, and treatment of nosocomial infections at neurosurgical patients were discussed according to principles of evidence-based medicine. We represented data about main groups of nosocomial infections — postoperative pyoninflammatory complication, including the definition of neurosurgical site infection, pneumonia, intravascular device-related and urinary tract infection.
In this review article currently available data on the prevention of nosocomial infections at neurosurgical patients were discussed in accordance to the principles evidence-based medicine. The large attention was given to basic groups of nosocomial infections — postoperative craniocerebral inflammatory complications, including the surgical site infection, and extracranial complications — pneumonia, intravascular device-related infection, urinary tract infection. A method of classifying of neurosurgical operations was submitted to identify patients at the highest risk of developing the nosocomial infections and effective regimens of the antimicrobial prophylaxis. In connection with absence of the National antiepidemic Programs and argued practice guidelines on the given problem the material deserves attentive study and introduction in the neurosurgical practice.
Currently available data on the diagnosis, and treatment of nosocomial infections at neurosurgical patients were discussed according to principles of evidence-based medicine. We represented data about main groups of nosocomial infections — postoperative pyoninflammatory complication, including the definition of neurosurgical site infection, pneumonia, intravascular device-related and urinary tract infection.
The inflammatory complications of shunt operations in 1990–1999 and 2005 years were analyzed. The frequency of the inflammatory complications was 5,2 and 5,1%. Some changes in infections’ etiology and their pharmacoresistance were established. In 2005 the amount of hydrocephaly cases, combined with congenital CNS disorders and cases of gram-positive microorganisms have increased. Also pharmacoresistance to the traditional antibiotics increased. The risk factors of inflammatory complications development after shunt operations were established.
The inflammatory complications of shunt operations in 1990–1999 and 2005 years were analyzed. The frequency of the inflammatory complications was 5,2 and 5,1%. Some changes in infections’ etiology and their pharmacoresistance were established. In 2005 the amount of hydrocephaly cases, combined with congenital CNS disorders and cases of gram-positive microorganisms have increased. Also pharmacoresistance to the traditional antibiotics increased. The risk factors of inflammatory complications development after shunt operations were established.
The article highlights the modern problems of nosocomial infections in the Neurosurgery. The rate of postoperative craniocerebral pyoinflammatory complications following clean neurosurgery varied from 3,0% to10,0%.The most rate of craniocerebral pyoinflammatory complications following head injuries varied from 20—29% to 64%.Concurrent infections, surgical approaches via parabasal sinuses and transsphenoidal approaches and CSF leakage at the operation site were considered as risk factors for postoperative CNS infections complications. The article represents «problem» agents of nosocomial infection including the opportunistic multiply resistant bacterial pathogens and agents of human invasive mycoses. The directions of rational antimicrobial therapy based on the given microbiological researches are considered.
The authors review 31 cases of postoperative craniocerebral pyoninflammatory complications in neurooncological patients from 1996 to 2000. The retrospective analysis of the risk factors including intraoperative, postoperative factors and those intrinsic to infection was carried out. The presence of one or two risk factors had no appreciable effect on the results of antimicrobial therapy given to neurooncological patients. Multiple risk factors (more than two) led to a negative prognosis. The neurooncological patients having multiple risk factors presented the high risk group in the postoperative period because their condition was associated with serious morbility and mortality as well as high cost of therapy. Dominant were the complications developed in 27 patients (87%) within more than 7 days after operation (10,2 days at the average). Positive results of antimicrobial therapy were found in 11 patients (40%). Over 80% of infections were caused by Gram-negative bacteria, 37% of these by Acinetobacter baumannii (10 cases).
