Infekcije povezane sa sustavima za trajnu odvodnju cerebrospinalnog likvora

master's thesis

• 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; School of Medicine; (Department of Infectious Diseases); Zagreb
• Defense date and country: 2019-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Infectology

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; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2019-11-22 13:23:56