title: [Combined intravenous and intrathecal vancomycin in treatment of patients with intracranial infections after craniotomy].
abstract: OBJECTIVE
  To explore the efficacy and safety of combined intravenous and intrathecal vancomycin in treatment of patients with intracranial infection after craniotomy.
  
  
  METHODS
  Clinical data of a total of 60 consecutive patients with intracranial infections after cranial operation admitted to Department of Neurosurgery of Nanfang Hospital of Southern Medical University from June 1st 2013 to June 1st 2015 were retrospectively analyzed. The patients were divided into two groups: intravenous injection only (n = 25) and combined intravenous and intrathecal injection (n = 35). In both groups of patients intravenously given vancomycin hydrochloride 500 kU every 6 hours as well as third or fourth generation of cephalosporins or meropenem. In combined intravenous and intrathecal injection group, in addition to 20 mg vancomycin was slowly injected via lumbar puncture after release of cerebrospinal fluid (CSF) once a day. The clinical efficacy and complications of the two groups were compared.
  
  
  RESULTS
  The recovery rate in the combined intravenous and intrathecal injection group was significantly higher than that in the intravenous injection only group (94.3% vs. 76.0%, χ (2) = 4.220, P = 0.040). Lowering of white blood cell count in combined intravenous and intrathecal injection group was significantly earlier than that of the intravenous injection only group (time to become normal: 8 days vs. 13 days). The time of recovery in combined intravenous and intrathecal injection group was significantly shorter than that of the intravenous injection only group (days: 9.9±0.7 vs. 13.4±1.1, t = -2.716, P = 0.009). There were 3 patients who experienced nerve root irritation symptoms in combined intravenous and intrathecal injection group. Symptomatic treatment was given and injection speed was slowed down for these patients. There were no severe complications, such as coma, epilepsy or death in both groups.
  
  
  CONCLUSIONS
  Combined intravenous and intrathecal injection of vancomycin could be a safe and effective therapy for intracranial infection after craniotomy.
authors.affiliation: Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong, China. Corresponding author: Qiu Binghui, Email: qiubinghui@139.com.
authors.forename: Yun
authors.initials: Y
authors.lastname: Bao
authors.forename: Binghui
authors.initials: B
authors.lastname: Qiu
authors.forename: Hao
authors.initials: H
authors.lastname: Zeng
authors.forename: Yiping
authors.initials: Y
authors.lastname: Mo
authors.forename: Nannan
authors.initials: N
authors.lastname: Zhang
authors.forename: Songtao
authors.initials: S
authors.lastname: Qi
mesh_terms: D002494:Central Nervous System Infections / Q000188:drug therapy*; D002511:Cephalosporins / Q000627:therapeutic use; D003399:Craniotomy / Q000009:adverse effects*; D006801:Humans; D007275:Injections, Intravenous; D007278:Injections, Spinal; D000077731:Meropenem; D012189:Retrospective Studies; D013845:Thienamycins / Q000627:therapeutic use; D014640:Vancomycin / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D002511:Cephalosporins; D013845:Thienamycins; D014640:Vancomycin; D000077731:Meropenem