Etiology and Antimicrobial Therapy of Intracranial Pyo-Inflammatory Complications

Kubrakov .

Vitebsk State Medical University, Vitebsk, Belorussia


According to medical literature, intracranial pyo-inflammatory complications (IPIC) are watched in 9.7-29.5% of cases.

The research goal was to study a structure of infecting agents, being a cause of IPIC, and their resistance to antibiotics, as well as to optimize treatment.

Material and Methods. We examined 74 cases with IPIC. The diagnosis was as follows: meningitis (32), meningoencephalitis (17), abscess formation (11), osteomyelitis (8), suppuration of a postoperative wound (6). The abscess content, liquor and purulent wound discharge were studied. The ATB Expression biochemical analyzer was used for identification of infecting agents and estimation of their antibiotic sensitivity.

Results and Discussion. The analysis of 42 cultures was carried out and 48 infecting agents were isolated. Among them one can mention Staphylococcus (26 strains; 54.1%), representatives of Enterobacteriaceae (11 strains; 22.9%), Streptococcaceae (7 strains; 14.5%), Pseudomonadacea (4; 8.3%). As for Staphylococcus, it was represented by S. aureus (15 strains; 57.6%) and such coagulase-negative staphylococci, as S. saprophyticus (8 strains; 30.7%) and S. epidermidis (3 strains; 11.5%). E. coli (80%) was a predominant strain among enterobacteria. Mono-microbial infection was watched in 89.6% of cases. S. aureus turned out to be sensitive to amikacin, ciprofloxacin and meronem (100% of cases), vancomycin (84%), ofloxacin (87.5%), cefotaxime (76.7%), oxacillin (33.3%). Strains of coagulase-negative staphylococci were sensitive to ciprofloxacin, amikacin and cefotaxime (90%), vancomycin (70%), ampicillin (55%). Enterobacteria were sensitive to ciprofloxacin, amikacin and meronem (100%), ofloxacin (84%), erfazolin (50%), clindamicin (33%). Streptococci were sensitive to cefalotin, amikacin, ofloxacin and meronem (100%), vancomycin (67%), cefotaxime (50%); they were insensitive to oxacillin (0%). Pseudomonas were sensitive to amikacin, ciprofloxacin and meronem (100%), cefotaxime (25%).

Staphylococci and enterobacteria are the most frequent cause of IPIC (1). It is expedient to use cephalosporins of the third generation and aminoglycosides for empiric antibiotic therapy (2).