Efficacy and safety of combined intraventricular/intrathecal and intravenous polymyxin B for postsurgical neurosurgical infections due to MDR/XDR-GNB: a retrospective cohort study.
4 affiliations
- 1Department of Critical care medicine, West China Hospital, Sichuan University, Guoxue Alley 37, Wuhou District, Chengdu, Sichuan, China.
- 2West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China.
- 3Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China.
- 4Department of Critical care medicine, West China Hospital, Sichuan University, Guoxue Alley 37, Wuhou District, Chengdu, Sichuan, China. [email protected].
Abstract
Background
Intracranial infections caused by multidrug-resistant or extensively drug-resistant Gram-negative bacteria (MDR/XDR-GNB) represent a significant challenge in neurosurgical critical care, with limited effective treatment options. This study aimed to evaluate the efficacy and safety of intraventricular/intrathecal (IVT/ITH) and intravenous polymyxin B in patients with post-neurosurgical MDR/XDR-GNB intracranial infections, focusing on long-term outcomes and neurotoxicity.Methods
This multicenter retrospective cohort study was conducted across seven hospitals in the West China region between December 2019 and June 2021. Patients with culture-confirmed MDR/XDR-GNB intracranial infection were enrolled and divided into two groups based on whether they received IVT/ITH polymyxin B. The primary outcome was 90-day mortality, with secondary outcomes including pathogen clearance rate, neurological status at discharge, and adverse events. Cox proportional hazards models were used to estimate treatment effects.Results
A total of 70 patients were included, with 24 in the IVT/ITH group and 46 in the control group. Baseline characteristics were comparable between groups. The most common pathogens isolated were Acinetobacter baumannii (67.1%), Klebsiella pneumoniae (24.3%), and Pseudomonas aeruginosa (4.3%), with 98.6% of isolates susceptible to polymyxin B. IVT/ITH polymyxin B was associated with significantly improved 90-day survival (adjusted HR 0.50; 95% CI 0.26-0.98) and higher pathogen clearance rates (58.3% vs. 26.7%, p < 0.001). No significant differences in adverse effects, including neurotoxicity, were observed between groups, although a trend toward higher seizure incidence was noted in the IVT/ITH group.Conclusion
IVT/ITH and intravenous administration of polymyxin B significantly improved long-term survival and microbial clearance in patients with MDR/XDR-GNB intracranial infections, with a favorable safety profile. These findings support its use as a promising therapeutic strategy in resource-limited settings where this combined local-systemic regimen is not feasible.Trail registration
This study was approved by the Ethics Committee of West China Hospital, approval number 278.
Related
- Perioperative intravenous lidocaine for the prevention of chronic postsurgical pain: a systematic review and meta-analysis of randomized controlled trials
- Neurosurgical Outcomes of Epilepsy Surgery Between 2017 and 2025: A Retrospective ESSQ-19 Study From a Tertiary Care Center
- Clinical outcomes and prognostic factors of Ommaya reservoir-based intrathecal chemotherapy in lung cancer leptomeningeal metastasis: a retrospective cohort study
- Postsurgical Carpal Collapse Following Scaphoidectomy With Partial Wrist Fusion: A Retrospective Radiographic Study.
- Hemorrhage distribution, imaging-defined post-hemorrhagic ventricular dilatation, and clinical outcomes in neonates with intraventricular and cerebral parenchymal hemorrhage: a single-center retrospective cohort study
BibTeX
@article{wan2026efficacy,
title = {{Efficacy and safety of combined intraventricular/intrathecal and intravenous polymyxin B for postsurgical neurosurgical infections due to MDR/XDR-GNB: a retrospective cohort study.}},
author = {Ding-Yuan Wan and Mao-Wei Liang and Xin-Yao Luo and Xue Bai and Wei Dong},
journal = {BMC neurology},
year = {2026},
month = jul,
doi = {10.1186/s12883-026-05209-5},
url = {https://europepmc.org/article/MED/42968049},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Efficacy and safety of combined intraventricular/intrathecal and intravenous polymyxin B for postsurgical neurosurgical infections due to MDR/XDR-GNB: a retrospective cohort study.
AU - Ding-Yuan Wan
AU - Mao-Wei Liang
AU - Xin-Yao Luo
AU - Xue Bai
AU - Wei Dong
PY - 2026
DA - 2026/07/28
JO - BMC neurology
DO - 10.1186/s12883-026-05209-5
UR - https://europepmc.org/article/MED/42968049
AB - Background Intracranial infections caused by multidrug-resistant or extensively drug-resistant Gram-negative bacteria (MDR/XDR-GNB) represent a significant challenge in neurosurgical critical care, with limited effective treatment options. This study aimed to evaluate the efficacy and safety of intraventricular/intrathecal (IVT/ITH) and intravenous polymyxin B in patients with post-neurosurgical MDR/XDR-GNB intracranial infections, focusing on long-term outcomes and neurotoxicity.Methods This multicenter retrospective cohort study was conducted across seven hospitals in the West China region between December 2019 and June 2021. Patients with culture-confirmed MDR/XDR-GNB intracranial infection were enrolled and divided into two groups based on whether they received IVT/ITH polymyxin B. The primary outcome was 90-day mortality, with secondary outcomes including pathogen clearance rate, neurological status at discharge, and adverse events. Cox proportional hazards models were used to estimate treatment effects.Results A total of 70 patients were included, with 24 in the IVT/ITH group and 46 in the control group. Baseline characteristics were comparable between groups. The most common pathogens isolated were Acinetobacter baumannii (67.1%), Klebsiella pneumoniae (24.3%), and Pseudomonas aeruginosa (4.3%), with 98.6% of isolates susceptible to polymyxin B. IVT/ITH polymyxin B was associated with significantly improved 90-day survival (adjusted HR 0.50; 95% CI 0.26-0.98) and higher pathogen clearance rates (58.3% vs. 26.7%, p < 0.001). No significant differences in adverse effects, including neurotoxicity, were observed between groups, although a trend toward higher seizure incidence was noted in the IVT/ITH group.Conclusion IVT/ITH and intravenous administration of polymyxin B significantly improved long-term survival and microbial clearance in patients with MDR/XDR-GNB intracranial infections, with a favorable safety profile. These findings support its use as a promising therapeutic strategy in resource-limited settings where this combined local-systemic regimen is not feasible.Trail registration This study was approved by the Ethics Committee of West China Hospital, approval number 278.
SN - 1471-2377
ER -