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Background: Pyogenic brain abscess is a severe neurological infection associated with significant morbidity and mortality. Despite advances in diagnostic techniques, neurosurgical procedures, and antimicrobial therapy, managing pyogenic brain abscesses remains challenging. This article reviews the current understanding of the epidemiology, pathogenesis, diagnosis, and treatment of pyogenic brain abscesses, highlighting the importance of a multidisciplinary approach to improve patient outcomes. Materials and Methods: A comprehensive literature review was conducted using PubMed, Scopus, and Google Scholar databases. The search terms included "pyogenic brain abscess," "epidemiology," "pathogenesis," "diagnosis," "treatment," "antibiotic therapy," and "prognosis." Relevant articles published in English between 2010 and 2023 were selected, focusing on the most recent advances and evidence-based recommendations for managing pyogenic brain abscesses. Results: Pyogenic brain abscess is a life-threatening condition that requires prompt diagnosis and treatment. A multidisciplinary approach involving neurosurgeons, infectious disease specialists, and radiologists is necessary to manage pyogenic brain abscesses successfully. Conclusion: Early recognition, appropriate antibiotic therapy, and timely neurosurgical intervention are essential for improving patient outcomes and minimizing neurological sequelae. Antibiotic therapy and surgical approach should be tailored to the individual patient, considering factors such as the suspected pathogens, immune status, and the primary source of infection. Long-term follow-up is crucial, as recurrence and neurological sequelae are common among survivors. Continued research is needed to improve our understanding of this complex condition and develop more effective treatment strategies. [ABSTRACT FROM AUTHOR]

Background: Optimal management of intracranial infections relies on microbiological diagnosis and antimicrobial choice, but conventional culture-based testing is limited by pathogen viability and pre-sampling antimicrobial exposure. Broad-range 16S rRNA gene sequencing has been reported in the management of culture-negative infections but its utility in intracranial infection is not well-described. We studied the efficacy of 16S rRNA gene sequencing to inform microbiological diagnosis and antimicrobial choice in intracranial infections. Methods: This was a retrospective study of all intraoperative neurosurgical specimens sent for 16S rRNA gene sequencing over an 8-year period at a regional neurosurgical centre in the UK. Specimen selection was performed using multidisciplinary approach, combining neurosurgical and infection specialist discussion. Results: Twenty-five intraoperative specimens taken during neurosurgery from 24 patients were included in the study period. The most common reason for referral was pre-sampling antimicrobial exposure (68%). Bacterial rDNA was detected in 60% of specimens. 16S rRNA gene sequencing contributed to microbiological diagnosis in 15 patients and informed antimicrobial management in 10 of 24 patients with intracranial infection. These included targeted antibiotics after detection of a clinically-significant pathogen that had not been identified through other microbiological testing (3 cases), detection of commensal organisms in neurosurgical infection which justified continued broad cover (2 cases) and negative results from intracranial lesions with low clinical suspicion of bacterial infection which justified avoidance or cessation of antibiotics (5 cases). Conclusion: Overall, 16S rRNA gene sequencing represented an incremental improvement in diagnostic testing and was most appropriately used to complement, rather than replace, conventional culture-based testing for intracranial infection. [ABSTRACT FROM AUTHOR]

The synthesis of pseudo-healthy images, involving the generation of healthy counterparts for pathological images, is crucial for data augmentation, clinical disease diagnosis, and understanding pathology-induced changes. Recently, Generative Adversarial Networks (GANs) have shown substantial promise in this domain. However, the heterogeneity of intracranial infection symptoms caused by various infections complicates the model's ability to accurately differentiate between pathological and healthy regions, leading to the loss of critical information in healthy areas and impairing the precise preservation of the subject's identity. Moreover, for images with extensive lesion areas, the pseudo-healthy images generated by these methods often lack distinct organ and tissue structures. To address these challenges, we propose a three-stage method (localization, inpainting, synthesis) that achieves nearly perfect preservation of the subject's identity through precise pseudo-healthy synthesis of the lesion region and its surroundings. The process begins with a Segmentor, which identifies the lesion areas and differentiates them from healthy regions. Subsequently, a Vague-Filler fills the lesion areas to construct a healthy outline, thereby preventing structural loss in cases of extensive lesions. Finally, leveraging this healthy outline, a Generative Adversarial Network integrated with a contextual residual attention module generates a more realistic and clearer image.Our method was validated through extensive experiments across different modalities within the BraTS2021 dataset, achieving a healthiness score of 0.957. The visual quality of the generated images markedly exceeded those produced by competingmethods, with enhanced capabilities in repairing large lesion areas. Further testing on the COVID-19-20 dataset showed that our model could effectively partially reconstruct images of other organs. [ABSTRACT FROM AUTHOR]

Currently, the diagnosis of postneurosurgical intracranial infection is mainly dependent on cerebrospinal fluid (CSF) bacterial culture, which has the disadvantages of being time-consuming, having a low detection rate, and being easily affected by other factors. These disadvantages bring some difficulties to early diagnosis. Therefore, it is very important to construct a nomogram model to predict the risk of infection and provide a basis for early diagnosis and treatment. This retrospective study analyzed postneurosurgical patient data from the Fourth Affiliated Hospital of Harbin Medical University between January 2019 and September 2023. The patients were randomly assigned in an 8:2 ratio into the training cohort and the internal validation cohort. In the training cohort, initial screening of relevant indices was conducted via univariate analysis. Subsequently, the least absolute shrinkage and selection operator logistic regression identified significant potential risk factors for inclusion in the nomogram model. The model's discriminative ability was assessed using the area under the receiver operating characteristic curve, and its calibration was evaluated through calibration plots. The clinical utility of the model was determined using decision curve analysis and further validated by the internal validation cohort. Multivariate logistic regression analysis of the training cohort identified 7 independent risk factors for postoperative intracranial infection: duration of postoperative external drainage (odds ratio [OR] 1.19, P = 0.005), continued fever (OR 2.11, P = 0.036), CSF turbidity (OR 2.73, P = 0.014), CSF pressure (OR 1.01, P = 0.018), CSF total protein level (OR 1.26, P = 0.026), CSF glucose concentration (OR 0.74, P = 0.029), and postoperative serum albumin level (OR 0.84, P < 0.001). Using these variables to construct the final model. The area under the receiver operating characteristic curve value of the model was 0.868 in the training cohort and 0.900 in the internal validation cohort. Calibration and the decision curve analysis indicated high accuracy and clinical benefit of the nomogram, findings that were corroborated in the validation cohort. This study successfully developed a novel nomogram for predicting postoperative intracranial infection, demonstrating excellent predictive performance. It offers a pragmatic tool for the early diagnosis of intracranial infection. [ABSTRACT FROM AUTHOR]

Background/Aim: Although chemotherapy for colorectal cancer has advanced remarkably, long-term chemotherapy can lead to a variety of infections. However, if chemotherapy must be discontinued to control infection, there is a risk of progression of colorectal cancer. Intracranial subdural empyema is a life-threatening intracranial infection. The condition requires 6-8 weeks of antibiotic therapy, and the patient must discontinue chemotherapy during treatment. We herein present a case of intracranial subdural empyema during long-term chemotherapy for metastatic rectal cancer. Case Report: A 69-year-old woman with unresectable metastatic rectal cancer had a convulsive seizure and was admitted to our hospital. The cause of the convulsive seizure was considered a metastatic brain tumor from rectal cancer. However, on the basis of contrast-enhanced computed tomography and contrastenhanced magnetic resonance imaging, we diagnosed intracranial subdural empyema. The infection was controlled by antibiotics, but chemotherapy for rectal cancer was discontinued during antibiotic treatment. As a result, the rectal cancer progressed, and the patient died 65 days after admission to our hospital. Conclusion: Intracranial subdural empyema may develop rarely during chemotherapy. This condition requires long-term treatment with antibiotics; therefore, early detailed imaging and diagnosis may improve the prognosis. [ABSTRACT FROM AUTHOR]

Guangming Yang,1,&ast; Jian Zhang,2,&ast; Qian Liu,2 Erqing Chai2 1The First Clinical School of Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu Province, 730000, People’s Republic of China; 2Gansu Provincial Hospital, Lanzhou, Gansu Province, 730000, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Erqing Chai, Email 18809407241@163.comAbstract: Inflammation of the frontal sinus is a relatively common clinical condition among paranasal sinusitis and is curable through anti-infection treatments, with a rare progression to frontal sinus abscess. An even rarer complication is the development of intracranial epidural empyema secondary to frontal sinus abscess. In this report, we describe a case of a 14-year-old male with a frontal sinus abscess that led to intracranial infection and was complicated by an epidural abscess misdiagnosed as an epidural hematoma. The primary symptoms were headache, dizziness, and fever. Following combined antibiotic therapy and surgical intervention, including maxillary and frontal sinus window drainage, the patient was cured. A follow-up period of three months showed no recurrence, indicating a favorable outcome.Keywords: sinusitis, frontal sinus abscess, intracranial infection, epidural abscess

Abstract It remains that intracranial infection has an alarming mortality and morbidity. Klebsiella pneumoniae (KP) have increasingly been isolated in ventriculitis and meningitis episodes. Intracranial infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) account for high mortality. To understand its clinical impact and related risk factors accurately are crucial in the management of bacterial intracranial infection. The retrospective study aimed to delineate the clinical risk of death from intracranial infection and analyze the risk factors. A total of 176 Klebsiella pneumoniae intracranial infectious patients were available to divide into CRKP group and carbapenem-susceptive Klebsiella Pneumoniae (CSKP) group. We performed survival analysis and estimate the time-varying effects of CRKP and CSKP infection on 30-day mortality. Infectious patients caused by CSKP was associated with lower mortality than CRKP group. The risk factors associated with death from intracranial infection caused by Klebsiella pneumoniae included SOFA scores, ventilator therapy, CRKP, and heart failure. Longer hospital stays are independently associated with lower mortality rates. Intracranial infection caused by CRKP was associated with excess mortality. Complex comorbidities mean higher mortality. Active supportive treatment is required for complicated patients with intracranial infections caused by carbapenem-resistant Klebsiella pneumoniae.

Objective: To evaluate the safety study of percutaneous gastroscopic gastrostomy in patients after ventriculoperitoneal shunt. Methods: We conducted a retrospective analysis of neurosurgical patients who underwent VPS and PEG at our hospital between January 2012 and November 2023. Patients were divided into 2 groups: VPS group and VPS followed by PEG gruop. Patients received routine antibiotic prophylaxis before the procedure, continued for 48 hours. Follow-up included monitoring immediate complications, particularly wound infection, intracranial infection, neurologic status deterioration, and shunt dysfunction. Routine follow-up visits were conducted post-discharge. Results: In the VPS group (n = 778), the incidence of intracranial infection was 3.08%. Among patients with PEG after VPS, the time interval between procedures ranged from 13 to 685 days. The mean follow-up period was 22 (1-77) months, with no deaths or further complications. Conclusion: Performing PEG more than 13 days after VPS does not significantly increase the risk of intracranial infections or PEG-associated infections, making it a relatively safe procedure. [ABSTRACT FROM AUTHOR]

Abstract Traumatic brain injury (TBI) is a major cause of morbidity and mortality globally. We unveiled the diagnostic value of serum NLRP3, metalloproteinase‐9 (MMP‐9) and interferon‐γ (IFN‐γ) levels in post‐craniotomy intracranial infections and hydrocephalus in patients with severe craniocerebral trauma to investigate the high risk factors for these in patients with TBI, and the serological factors predicting prognosis, which had a certain clinical predictive value. Study subjects underwent bone flap resection surgery and were categorized into the intracranial infection/hydrocephalus/control (without postoperative hydrocephalus or intracranial infection) groups, with their clinical data documented. Serum levels of NLRP3, MMP‐9 and IFN‐γ were determined using ELISA kits, with their diagnostic efficacy on intracranial infections and hydrocephalus evaluated by receiver operating characteristic curve analysis. The independent risk factors affecting postoperative intracranial infections and hydrocephalus were analysed by logistic multifactorial regression. The remission after postoperative symptomatic treatment was counted. The intracranial infection/control groups had significant differences in Glasgow Coma Scale (GCS) scores, opened injury, surgical time and cerebrospinal fluid leakage, whereas the hydrocephalus and control groups had marked differences in GCS scores, cerebrospinal fluid leakage and subdural effusion. Serum NLRP3, MMP‐9 and IFN‐γ levels were elevated in patients with post‐craniotomy intracranial infections/hydrocephalus. The area under the curve values of independent serum NLRP3, MMP‐9, IFN‐γ and their combination for diagnosing postoperative intracranial infection were 0.822, 0.722, 0.734 and 0.925, respectively, and for diagnosing hydrocephalus were 0.865, 0.828, 0.782 and 0.957, respectively. Serum NLRP3, MMP‐9 and IFN‐γ levels and serum NLRP3 and MMP‐9 levels were independent risk factors influencing postoperative intracranial infection and postoperative hydrocephalus, respectively. Patients with hydrocephalus had a high remission rate after postoperative symptomatic treatment. Serum NLRP3, MMP‐9 and IFN‐γ levels had high diagnostic efficacy in patients with postoperative intracranial infection and hydrocephalus, among which serum NLRP3 level played a major role.

Objective: To investigate the risk factors of intracranial infection caused by craniotomy and the clinical therapeutic effect. Methods: The case data of 661 patients who underwent craniotomy in our hospital from January 2018 to December 2022 were retrospectively selected. Clinical data of patients undergoing craniotomy were collected to determine the occurrence of intracranial infection caused by craniotomy. The risk factors of intracranial infection after craniotomy were determined by univariate and binary Logistic retrospective analysis. To analyze the distribution and composition of pathogenic bacteria in intracranial infected patients and the therapeutic effect of intracranial infected patients after craniotomy. Results: The incidence of postoperative intracranial infection was 5.75% in 661 patients with craniotomy. Among 38 patients with intracranial infection after craniotomy, there were 30 cases of gram-positive bacteria, accounting for 81.58% (31/38), 8 cases of gram-negative bacteria, accounting for 18.42%(7/38), and staphylococcus, accounting for 78.95%(30/38), accounted for the largest proportion. The protective factors were preoperative prophylactic antibiotics, and the risk factors were operative time 4 h, albumin level 36 g/L, postoperative cerebrospinal fluid leakage, indwelling drainage tube, and infratentorial surgery(P<0.05). Among the 38 patients, 33 were cured and 5 had no clinical symptoms at discharge. All patients were followed up by outpatient or telephone for 3-6 months after discharge, and there was no recurrence of inflammation. Conclusion: After craniotomy postoperative incidence of intracranial infection is 5.75%, protective factors for preoperative prophylactic antibiotics, risk factors for operation time 4 h, albumin level 36 g/L, postoperative cerebrospinal fluid leakage, indwelling drainage tube, screen operation, craniotomy postoperative intracranial infection accounted for the most, by giving active treatment, for confirmed craniotomy postoperative intracranial patients infection, early diagnosis and give sufficient amount of sensitive antibiotics treatment. [ABSTRACT FROM AUTHOR]

Objective To analyze the status of the bacteria in the operative area of transnasal skull base surgery and its correlation with postoperative intracranial infection. Methods The procedure of transnasal skull base surgery was divided into three stages: nasal passage preparation(stage 1), tumor resection(stage 2), and skull base reconstruction(stage 3). Bacterial sampling was taken from the mucosa of the anterior wall of sphenoid sinus or clival recess of sellar floor at the beginning of each stage; and the positive rate of bacterial culture in different stages of operation and its correlation with postoperative intracranial infection were analyzed. Results A total of 105 patients were enrolled in this study, and 315 samples were taken. The average time point of sampling in the three stages was 20.3, 45.1 and 131.3 min after the beginning of operation, respectively. The positive results were 9 cases(2.9%)in the stage 1, 8 cases(2.5%)in the stage 2, and 23 cases(7.3%)in the stage 3, which were 24 cases of Staphylococcus epidermidis, 7 cases of Staphylococcus aureus, 3 cases of hemolytic streptococcus, 2 cases of Klebsiella pneumonia, and 4 cases of Escherichia coli. There was no significant difference in the positive cases between stage 1 and stage 2(P=0.955), but there were significant differences between stage 1 or 2 and stage 3(P=0.013; P=0.007). There were 36(11.4%)patients with at least one positive result in the three stages, 17(16.2%)with cerebrospinal fluid leakage, and 12(11.4%)with intracranial infection. The risk of intracranial infection was 3.1 times higher in patients with positive bacterial culture than patients with negative bacterial culture(OR=3.1, 95% CI :0.9-10.6), which was not statistically significant; patients with CSF leakage were 61.4 times higher than those without CSF leakage(OR=61.4, 95% CI:11.2-337.1), which was statistically significant(P<0.001). The consistency rate of bacteria in nasal cavity and postoperative cerebrospinal fluid culture was 57.1%. Conclusion The positive rate of bacterial culture in the operative area of transnasal skull base surgery increases significantly with the extension of operation time, which is a potential risk index of postoperative intracranial infection. [ABSTRACT FROM AUTHOR]

Traumatic brain injury (TBI) is a major cause of morbidity and mortality globally. We unveiled the diagnostic value of serum NLRP3, metalloproteinase‐9 (MMP‐9) and interferon‐γ (IFN‐γ) levels in post‐craniotomy intracranial infections and hydrocephalus in patients with severe craniocerebral trauma to investigate the high risk factors for these in patients with TBI, and the serological factors predicting prognosis, which had a certain clinical predictive value. Study subjects underwent bone flap resection surgery and were categorized into the intracranial infection/hydrocephalus/control (without postoperative hydrocephalus or intracranial infection) groups, with their clinical data documented. Serum levels of NLRP3, MMP‐9 and IFN‐γ were determined using ELISA kits, with their diagnostic efficacy on intracranial infections and hydrocephalus evaluated by receiver operating characteristic curve analysis. The independent risk factors affecting postoperative intracranial infections and hydrocephalus were analysed by logistic multifactorial regression. The remission after postoperative symptomatic treatment was counted. The intracranial infection/control groups had significant differences in Glasgow Coma Scale (GCS) scores, opened injury, surgical time and cerebrospinal fluid leakage, whereas the hydrocephalus and control groups had marked differences in GCS scores, cerebrospinal fluid leakage and subdural effusion. Serum NLRP3, MMP‐9 and IFN‐γ levels were elevated in patients with post‐craniotomy intracranial infections/hydrocephalus. The area under the curve values of independent serum NLRP3, MMP‐9, IFN‐γ and their combination for diagnosing postoperative intracranial infection were 0.822, 0.722, 0.734 and 0.925, respectively, and for diagnosing hydrocephalus were 0.865, 0.828, 0.782 and 0.957, respectively. Serum NLRP3, MMP‐9 and IFN‐γ levels and serum NLRP3 and MMP‐9 levels were independent risk factors influencing postoperative intracranial infection and postoperative hydrocephalus, respectively. Patients with hydrocephalus had a high remission rate after postoperative symptomatic treatment. Serum NLRP3, MMP‐9 and IFN‐γ levels had high diagnostic efficacy in patients with postoperative intracranial infection and hydrocephalus, among which serum NLRP3 level played a major role. What is the central question of this study?Severe craniocerebral injury usually leads to the loss of nerve function: what is the diagnostic value of serum NLRP3, metalloproteinase‐9 (MMP‐9) and interferon‐γ (IFN‐γ) levels in the diagnosis of intracranial infections and hydrocephalus in patients with severe craniocerebral trauma after craniotomy?What is the main finding and its importance?Serum NLRP3, MMP‐9, and IFN‐γ levels had high diagnostic efficacy in patients with postoperative intracranial infection and hydrocephalus, among which serum NLRP3 level played a major role. [ABSTRACT FROM AUTHOR]

Objective: Otitis media and sinusitis are common childhood infections, typically mild with good outcomes. Recent studies show a rise in intracranial abscess cases in children, raising concerns about a link to COVID-19. This study compares a decade of data on these cases before and after the pandemic. Methods: This retrospective comparative analysis includes pediatric patients diagnosed with otitis media and sinusitis, who later developed intracranial abscesses over the past decade. We collected comprehensive data on the number of cases, patient demographics, symptoms, treatment, and outcomes. Results: Between January 2013 and July 2023, our center identified 10 pediatric patients (median age 11.1years, range 2.2–18.0 years, 60% male) with intracranial abscesses from otitis media and sinusitis. Of these, 7 cases (70%, median age 9.7 years, range 2.2–18.0 years) occurred since the onset of the COVID-19 pandemic, while the remaining 3 cases (30%, median age 13.3 years, range 9.9–16.7 years) were treated before the pandemic. No significant differences were found in otolaryngological associations, surgical interventions, preoperative symptoms, lab findings, or postoperative antibiotics between the two groups. All patients showed positive long-term recovery. Conclusion: This study reveals 5-fold increase of pediatric otogenic and sinogenic intracranial abscess cases in the last three-years since the onset of the COVID-19 pandemic. While further investigation is needed, these findings raise important questions about potential connections between the pandemic and the severity of otitis media and sinusitis complications in children. Understanding these associations can improve pediatric healthcare management during infectious disease outbreaks. [ABSTRACT FROM AUTHOR]

Background In this retrospective study, we explore the clinical risk factors correlated to the prognosis of patients who suffered from central nervous system infection after a neurosurgical procedure. Methods The study included 113 patients diagnosed with a postoperative intracranial infection. Several factors with clinical relevance were identified and analyzed by univariate analyses. The risk factors that showed any significant difference between the cases were analyzed by multivariate logistic regression analyses. Results Here we show that the duration of the drainage before infection (measured in days; Beta [B]: –0.113; odds ratio [OR]: 0.893; 95% confidence interval [CI]: 0.805–0.991; p = 0.033), the number of antibiotics used for the treatment (B: –1.470; OR: 0.230; 95% CI: 0.072–0.738; p = 0.013), and the number of leucocytes in the cerebrospinal fluid (CSF; B: –0.016; OR: 0.984; 95% CI: 0.970–0.998; p = 0.027) are risk factors for the prognosis of patients with an intracranial infection. In contrast, the duration of antibiotic treatment (measured in days; B: 0.176; OR: 1.193; 95% CI: 1.063–1.339; p = 0.003) turned out to be a positive factor for recovery from infection. Conclusions Our results suggest that early identification of the correlated risk factors can improve the prognosis of patients with intracranial infection after neurosurgery. [ABSTRACT FROM AUTHOR]

Abstract Multidrug-resistant (MDR) Acinetobacter baumannii (A. baumannii) is a formidable pathogen responsible for severe intracranial infections post-craniotomy, exhibiting a mortality rate as high as 71%. Tigecycline (TGC), a broad-spectrum antibiotic, emerged as a potential therapeutic agent for MDR A. baumannii infections. Nonetheless, its clinical application was hindered by a short in vivo half-life and limited permeability through the blood–brain barrier (BBB). In this study, we prepared a novel core–shell nanoparticle encapsulating water-soluble tigecycline using a blend of mPEG-PLGA and PLGA materials. This nanoparticle, modified with a dual-targeting peptide Aβ11 and Tween 80 (Aβ11/T80@CSs), was specifically designed to enhance the delivery of tigecycline to the brain for treating A. baumannii-induced intracranial infections. Our findings demonstrated that Aβ11/T80@CSs nanocarriers successfully traversed the BBB and effectively delivered TGC into the cerebrospinal fluid (CSF), leading to a significant therapeutic response in a model of MDR A. baumannii intracranial infection. This study offers initial evidence and a platform for the application of brain-targeted nanocarrier delivery systems, showcasing their potential in administering water-soluble anti-infection drugs for intracranial infection treatments, and suggesting promising avenues for clinical translation. Graphical abstract

Multidrug-resistant (MDR) Acinetobacter baumannii (A. baumannii) is a formidable pathogen responsible for severe intracranial infections post-craniotomy, exhibiting a mortality rate as high as 71%. Tigecycline (TGC), a broad-spectrum antibiotic, emerged as a potential therapeutic agent for MDR A. baumannii infections. Nonetheless, its clinical application was hindered by a short in vivo half-life and limited permeability through the blood–brain barrier (BBB). In this study, we prepared a novel core–shell nanoparticle encapsulating water-soluble tigecycline using a blend of mPEG-PLGA and PLGA materials. This nanoparticle, modified with a dual-targeting peptide Aβ11 and Tween 80 (Aβ11/T80@CSs), was specifically designed to enhance the delivery of tigecycline to the brain for treating A. baumannii-induced intracranial infections. Our findings demonstrated that Aβ11/T80@CSs nanocarriers successfully traversed the BBB and effectively delivered TGC into the cerebrospinal fluid (CSF), leading to a significant therapeutic response in a model of MDR A. baumannii intracranial infection. This study offers initial evidence and a platform for the application of brain-targeted nanocarrier delivery systems, showcasing their potential in administering water-soluble anti-infection drugs for intracranial infection treatments, and suggesting promising avenues for clinical translation. [ABSTRACT FROM AUTHOR]

Pseudorabies virus can cause inflammation in the central nervous system and neurological symptoms. To further investigate the protective mechanism of PRV XJ delgE/gI/TK in the central nervous system, an intracranial PRV-infection mice model was developed. The results demonstrated that immunization with PRV XJ delgE/gI/TK successfully prevented death caused by PRV-intracranial infection. Subsequently, the brains were collected for transcriptome and metabolome analysis. GO and KEGG enrichment analysis indicated that the differentially expressed genes were primarily enriched in pathways such as TNF, NOD-like receptor, JAK-STAT, MAPK, IL-17 and apoptosis signaling. Metabolomics analysis revealed that the differential metabolites were mainly associated with pathways such as fatty acid degradation, arachidonic acid metabolism, linoleic acid metabolism and unsaturated fatty acid biosynthesis. The combined analysis of metabolites and differentially expressed genes revealed a strong correlation between the differential metabolites and TNF, PI3K, and MAPK signaling pathways. Anti-inflammatory metabolites have been shown to inhibit the inflammatory response and prevent mouse death caused by PRV infection. Notably, when glutathione was injected intracranially and dihydroartemisinin was injected intraperitoneally, complete protection against PRV-induced death in mice was observed. Moreover, PRV activates the PI3K/AKT signaling pathway. In conclusion, our study demonstrates that PRV XJ delgE/gI/TK can protects intracranially infected mice from death by regulating various metabolites with anti-inflammatory functions postimmunization. [ABSTRACT FROM AUTHOR]

Background: To explore the therapeutic effect of hyperbaric oxygen combined with subdural drilling and drainage (SDD) on subdural effusion type IV with intracranial infection in infant patients. Methods: This retrospective controlled study included 328 infant patients with subdural effusion type 4 with intracranial infection between January 2005 and January 2023. 178 patients were treated by hyperbaric oxygen combined with SDD (group A). 142 cases were treated with SDD (group B). 97 infants were only received hyperbaric oxygen (group C). Clinical outcomes, the control time of intracranial infection, complications, and the degree of brain re-expansion after 6 months of treatment were compared among the three groups. According to the comprehensive evaluation of treatment effectiveness and imaging results, it is divided into four levels: cured, significantly effective, improved, and ineffective. Results: No patient died during follow-up. The three groups were similar regarding age, sex, the general information, and clinical symptoms (p>0.05). All intracranial infections in the children were effectively controlled. There was no difference in infection control time between group A and group B, and there was no statistical significance. However, the control time of intracranial infection between the two groups was different from that of group C, which was statistically significant. Compared with group B and group C, the degree of brain re-expansion in group A has obvious advantages and significant differences. The effective rates of the three groups were 83.7%, 58.5%, and 56.7%, respectively. There were 28 cases of subcutaneous hydrops in group A and 22 cases of subcutaneous hydrops in group B after operation, and no other serious complications. Conclusion: The SDD is safe and effective for infant patients with intracranial infections through fluid replacement and intrathecal antibacterial. Hyperbaric oxygen is effective as an adjuvant therapy to promote brain re-expansion. [ABSTRACT FROM AUTHOR]

Abstract Objective To investigate the relationship between suprasellar extension (SSE) and intracranial infection after endoscopic endonasal transsphenoidal approach (EETA) for pituitary adenoma resection. Methods We retrospectively analyzed 94 patients with suprasellar extended pituitary adenoma admitted to the Department of Neurosurgery of the Affiliated Hospital of Guilin Medical College from January 2018 to December 2021. We measured the preoperative magnetic resonance sagittal SSE and collected clinical data and divided the patients into groups according to the presence of postoperative intracranial infection. The critical value for the SSE was calculated by using a working characteristic curve for the subjects. The risk factors for intracranial infection after EETA resection of pituitary adenomas were analyzed by multivariate regression analysis. Results Among the 94 patients, 12 cases (12.8%) were placed in the infection group and 82 cases (87.2%) in the non-infection group. The cut-off value for the SSE in the sagittal position was 15.6 mm, the sensitivity was 75%, the specificity was 87.8%, and the area under the curve (AUC) was 0.801. The coronary cut-off value for the SSE was 15.8 mm, the sensitivity was 66.7%, the specificity was 79.3%, and the AUC was 0.787. The SSE values in the sagittal and coronal positions were correlated with postoperative intracranial infection (P

Background: Hydrocephalus with intracranial infection (Hll) may cause pathological changes in brain tissue structure and irreversible damage to the nervous system. However, intracranial infection is a contraindication to ventriculo-peritoneal (VP) shunt surgery, and the prognosis is improved by early infection control and intracranial pressure reduction. This study evaluated the safety and efficacy of the Ommaya reservoir vs. modified externai ventricular drainage (M-EVD) in the management of Hll in pediatric patients. Methods: This retrospective controlled study included 45 pediatric patients with Hll treated with an Ommaya reservoir (n = 24) or M-EVD (n = 21) between January 2018 and December 2022. Clinical outcomes, cerebrospinal fluid (CSF) test results, complications, and outcomes were compared between the Ommaya reservoir and M-EVD groups. Results: No patient died during the follow-up period. The two groups were similar regarding age, sex, admission temperature, weight, preoperative serum protein and albumin concentrations, CSF analysis (white blood cell count, glucose concentration, and protein content), and clinical symptoms (P > 0.05). Both groups had significant changes in the CSF test results postoperatively compared with preoperatively (P < 0.05). In the M-EVD group, the median days for 13 children to remove the externai drainage tube and receive VP shunt was 19 days. The longest drainage tube retention time was 61 days, and there was no intracranial infection or serious complication related to the drainage tube. After the placement of the Ommaya, the median time required for CSF to return to normal was 21 days, and a total of 15 patients underwent VP shunt surgery. Conclusion: The Ommaya reservoir and M-EVD are safe and effective for pediatric patients with Hll. Both methods reduce the intracranial pressure and alleviate the symptoms of hydrocephalus, although there are differences between the two methods. [ABSTRACT FROM AUTHOR]

Background: Neuroinflammation is a common feature of many neurological diseases, and remains crucial for disease progression and prognosis. Activation of microglia and astrocytes can lead to neuroinflammation. However, little is known about the role of lncRNA xist and miR-122-5p in the pathogenesis of sepsis-associated neuroinflammation (SAN). This study aims to investigate the role of lncRNA xist and miR-122-5p in the pathogenesis of SAN. Methods: Levels of miR-122-5p and proinflammatory mediators were detected in the cerebrospinal fluid (CSF) of patients with intracranial infection (ICI) by ELISA and qRT-PCR. miRNA expression in the periventricular white matter (PWM) in rats was analyzed by high-throughput sequencing. Levels of lncRNA xist, miR-122-5p and proinflammatory mediators in the PWM were measured using qRT-PCR and western blot. Bioinformatics analysis was used to predict the upstream and downstream of miR-122-5p. The interaction between miR-122-5p and its target protein was validated using luciferase reporter assay. BV2 and astrocytes were used to detect the expression of lncRNA xist, miR-122-5p. Results: The level of miR-122-5p was significantly decreased in the CSF of ICI patients, while the expression of IL-1β and TNF-α were significantly upregulated. Furthermore, it was found that the expression of IL-1β and TNF-α were negatively correlated with the level of miR-122-5p. A high-throughput sequencing analysis showed that miR-122-5p expression was downregulated with 1.5-fold changes in the PWM of CLP rats compared with sham group. Bioinformatics analysis found that lncRNA xist and PKCη were the upstream and downstream target genes of miR-122-5p, respectively. The identified lncRNA xist and PKCη were significantly increased in the PWM of CLP rats. Overexpression of miR-122-5p or knockdown of lncRNA xist could significantly downregulate the level of PKCη and proinflammatory mediators from activated microglia and astrocytes. Meanwhile, in vitro investigation showed that silencing lncRNA xist or PKCη or enhancing the expression of miR-122-5p could obviously inhibit the release of proinflammatory mediators in activated BV2 cells and astrocytes. Conclusion: LncRNA xist could regulate microglia and astrocytes activation in the PWM of CLP rats via miR-122-5p/PKCη axis, further mediating sepsis associated neuroinflammation. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship between suprasellar extension (SSE) and intracranial infection after endoscopic endonasal transsphenoidal approach (EETA) for pituitary adenoma resection. Methods: We retrospectively analyzed 94 patients with suprasellar extended pituitary adenoma admitted to the Department of Neurosurgery of the Affiliated Hospital of Guilin Medical College from January 2018 to December 2021. We measured the preoperative magnetic resonance sagittal SSE and collected clinical data and divided the patients into groups according to the presence of postoperative intracranial infection. The critical value for the SSE was calculated by using a working characteristic curve for the subjects. The risk factors for intracranial infection after EETA resection of pituitary adenomas were analyzed by multivariate regression analysis. Results: Among the 94 patients, 12 cases (12.8%) were placed in the infection group and 82 cases (87.2%) in the non-infection group. The cut-off value for the SSE in the sagittal position was 15.6 mm, the sensitivity was 75%, the specificity was 87.8%, and the area under the curve (AUC) was 0.801. The coronary cut-off value for the SSE was 15.8 mm, the sensitivity was 66.7%, the specificity was 79.3%, and the AUC was 0.787. The SSE values in the sagittal and coronal positions were correlated with postoperative intracranial infection (P < 0.05). After univariate analysis, those with significant differences were included in the multivariate regression analysis. It was concluded that the extension distance of the tumor above the sella in the sagittal position was ≥ 15.6 mm, the tumor texture was hard, and the postoperative cerebrospinal fluid leakage were the independent risk factors for intracranial infection after EETA resection of suprasellar extended pituitary tumors (P < 0.05). Conclusions: The value of SSE on sagittal MRI can predict intracranial infection in patients with suprasellar extended pituitary adenoma after endoscopic endonasal transsphenoidal resection. This finding recommends neurosurgeons pay more attention to the imaging characteristics of pituitary adenomas and select appropriate treatment plans in combination with the intraoperative conditions to reduce the incidence of intracranial infection. [ABSTRACT FROM AUTHOR]

Background Various high-energy tasks in the construction industry can lead to craniocerebral injuries. Construction industry–associated penetrating craniocerebral injuries due to metal foreign bodies have unique characteristics. However, no norms exist for removing metal foreign bodies and preventing secondary trauma. This study aimed to explore the characteristics and treatment of construction industry–associated penetrating craniocerebral injuries due to metal foreign bodies. Methods Data of patients who suffered from penetrating injuries due to metal foreign bodies and were treated in the Zhongshan People's Hospital from 2001 to 2021 were collected based on the causes of injuries to explore disease characteristics and therapeutic effects. Results A total of six patients with penetrating craniocerebral injuries due to metal foreign bodies, who underwent surgeries, were included in the study. Five patients recovered well after the surgery, and one patient died. In four patients, intracranial infection complicated the course after surgery, and two patients had delayed intracranial hematoma. Conclusion Patients with construction industry–associated penetrating craniocerebral injuries due to metal foreign bodies are prone to coma and intracranial vascular injuries. Early surgical removal and prevention of intracranial infection are key to achieving good therapeutic effects. [ABSTRACT FROM AUTHOR]

Objective: To explore the risk factors of intracranial infection in neurosurgery patients after craniocerebral surgery, and to study the clinical efficacy of traditional Chinese medicine surgery "Tufa" as an auxiliary treatment for intracranial infection. Methods:Retrospectively analyze the clinical data of 260 patients who underwent craniocerebral surgery in neurosurgery of our hospital from January 2017 to December 2022, and analyze the influencing factors of postoperative intracranial infection. Patients with postoperative intracranial infection were treated with traditional Chinese medicine "Tuofe" on the basis of conventional anti infection treatment, and their clinical therapeutic efficacy, cerebrospinal fluid leukocyte count, protein content and neutrophils, as well as serum interleukin-8 (IL-8), hypersensitive C-reactive protein (hs CRP) and Calcitonin (PCT) after anti infection treatment were analyzed. Results: Among 260patients undergoing neurosurgery craniocerebral surgery, 21 patients had intracranial infection after surgery, and the incidence of postoperative intracranial infection was 8. 08%. Multivariate logistic regression analysis showed that operation time, cerebrospinal fluid shunt, external ventricular drainage and cerebrospinal fluid leakage were independent factors influencing whether intracranial infection occurred after neurosurgery craniocerebral surgery. After using the traditional Chinese medicine surgical "support method" to assist in anti infection treatment, the cerebrospinal fluid white blood cell count, protein content, and neutrophils of 21 patients with postoperative intracranial infection were significantly reduced compared to before treatment (P＜0. 05), and serum IL-8, hs CRP, and PCT were all reduced compared to before treatment (P＜0. 05) . The total effective rate, anti infection treatment time, and total cost of 21 postoperative intracranial infection patients were 90. 48% (11. 43 ±1. 57) days, and (7571. 68 ±2541. 29) yuan, respectively. Conclusion: Operation time, cerebrospinal fluid shunt, external ventricular drainage and cerebrospinal fluid leakage are independent influencing factors that affect whether intracranial infection occurs after craniocerebral surgery in neurosurgery patients. Traditional Chinese medicine surgery "support therapy" helps to improve the anti infection treatment effect of patients with intracranial infection after surgery. [ABSTRACT FROM AUTHOR]

Abstract Background Isolated Prevotella intermedia, a rare gram-negative, rod-shaped, anaerobic bacterium, is rarely detected in clinical practice. It has been associated with infections of the oral cavity and female genital tract, but has never been detected in cerebrospinal fluid (CSF) of patients in China. Accurate detection of causative pathogens is still an arduous task owing to the difficult conditions of anaerobic bacterial culture. Isolated Prevotella intermedia can be detected by metagenomic next generation sequencing (mNGS) of the CSF. Correct diagnosis and antibiotic treatment can help patients avoid life-threatening events. Case presentation Herein, we describe the case of a 64-year-old Chinese woman who presented with typical features of meningoencephalitis. Routine CSF culture failed to identify the causative pathogen. Isolated Prevotella intermedia was detected by mNGS, and the patient was treated with antibacterial agents including ceftriaxone, vancomycin, moxifloxacin, meropenem, metronidazole, and linezolid. The patient underwent surgical treatment for abscess of left frontal parietal lobe, which was observed on magnetic resonance imaging (MRI) and was suspected to be caused by Prevotella intermedia. It was further confirmed that it was a secondary infection from the oral cavity, and the possible etiology might have been dental surgery. Treatment was rendered to the patient based on metagenomic test result, and her condition improved after two months. Conclusions This case highlights the role of mNGS in accurate diagnosis of patients with central nervous system infection. In particular, mNGS can be used to identify rare pathogens and confirm the diagnosis in patients with unknown etiology.

BACKGROUND: Streptococcus anginosus group is a common cause of pediatric intracranial infections but treatment recommendations, including use of oral therapy, are poorly defined. METHODS: We performed a retrospective review from 2004 to 2019 of all patients with S anginosus group pyogenic intracranial infections at Childrens Hospital Colorado, highlighting patients transitioned to oral therapy. The primary endpoint was worsening infection necessitating intravenous antibiotics or a source control procedure after transition to oral therapy. RESULTS: Of 107 patients with S anginosus intracranial infections, 61 were transitioned to exclusive oral therapy after a median intravenous duration of 37 days, overwhelmingly with a levofloxacin-based regimen. Only 1 treatment failure was noted in a patient who did not fill their prescription. Patients with epidural infections were more likely to be transitioned to oral therapy within the first 28 days of treatment (defined as early). Patients with parenchymal infections, bacteremia, co-pathogens, higher inflammatory markers, and requiring >1 source control procedure were less likely to be transitioned early to oral therapy. Complications of a central catheter and/or intravenous medications contributed to 56% of oral transitions. CONCLUSIONS: Levofloxacin-based oral regimens were effective and well tolerated. Patients with less severe infections were more likely to be transitioned early to oral therapy. Criteria for transitioning patients to oral antibiotics for intracranial infections should be established to minimize risks inherent with central catheters.

ABSTRACT Introduction Haemophilus influenzae (Hi) is subdivided into typeable (a–f) and non‐typeable groups. Hi serotype b (Hib) has historically been one of the important pathogens responsible for invasive infection. However, after widespread Hib vaccination, the emergence of other Hi serotypes, specifically Hi serotype a (Hia), was noted during the last few decades, mostly in children younger than 5 years of age. Case presentation We present two cases of severe intracranial infections with detected Hia in patients > 5 years of age within a short time frame and within the same geographic area. Conclusion Epidemiological studies and surveillance on Hia‐related illnesses in all age groups worldwide are needed to better understand the clinical and epidemiological characteristics of Hia. This can establish a platform to develop a candidate vaccine against Hia that might protect children of all ages.

This article presents the diagnostic and therapeutic journey of a 14-year-old male patient diagnosed with Primary Amebic Meningoencephalitis (PAM), incorporates a review of pertinent literature and a discussion on recent advancements in the study of this condition. The patient presented with symptoms of fever and headache for three days, accompanied by seizures and a half-day episode of altered consciousness. Upon admission, clinical findings included a mild coma, respiratory distress, rigidity of limbs, and negative pathological reflexes. The patient's history showed in a local outdoor pond swimming in July and August of the same year. Metagenomic Next-Generation Sequencing (mNGS) of the cerebrospinal fluid identified the presence of Naegleria fowleri. Cranial CT and MRI scans indicated signs of brain edema and meningitis. The patient was confirmed with pediatric primary amebic meningoencephalitis. A 45-day comprehensive treatment regimen was administered, encompassing anti-amebic medications, anticonvulsant therapy, management of brain edema, and intracranial pressure reduction. This case represents the longest survival period recorded for such pediatric cases in China. The purpose of this report is to heighten clinical awareness of PAM, share diagnostic and therapeutic insights, expand upon existing treatment approaches, and ultimately contribute to improving the survival rates of PAM patients.

Listeria monocytogenes, is a Gram-positive facultative intracellular bacterium without spores. It can cause invasive diseases such as septicemia, meningitis, and encephalitis, and has a high mortality rate. This is a report on a recent case of neurolisteriosis isolated from cerebrospinal fluid sample of a patient with diabetes and chronic heart failure in our hospital. The patient initially received the combined treatment of cephalosporin and meropenem (both 1.0 g every 8 hours). We identified the pathogenic organism as L. monocytogenes using three identification methods: mass spectrometry, biochemical assays, and molecular techniques. After determining the pathogenic bacteria, we quickly informed the clinician and suggesting a change in antibiotic treatment and immediately discontinued cephalosporin and meropenem. The patient's symptoms were significantly improved after 9 days of penicillin G treatment, and the patient chose to be discharged for personal reasons. In conclusion, certain strains of wild-type Listeria monocytogenes can lead to identification errors that occur across platforms and methods.

Background: Isolated Prevotella intermedia, a rare gram-negative, rod-shaped, anaerobic bacterium, is rarely detected in clinical practice. It has been associated with infections of the oral cavity and female genital tract, but has never been detected in cerebrospinal fluid (CSF) of patients in China. Accurate detection of causative pathogens is still an arduous task owing to the difficult conditions of anaerobic bacterial culture. Isolated Prevotella intermedia can be detected by metagenomic next generation sequencing (mNGS) of the CSF. Correct diagnosis and antibiotic treatment can help patients avoid life-threatening events. Case presentation: Herein, we describe the case of a 64-year-old Chinese woman who presented with typical features of meningoencephalitis. Routine CSF culture failed to identify the causative pathogen. Isolated Prevotella intermedia was detected by mNGS, and the patient was treated with antibacterial agents including ceftriaxone, vancomycin, moxifloxacin, meropenem, metronidazole, and linezolid. The patient underwent surgical treatment for abscess of left frontal parietal lobe, which was observed on magnetic resonance imaging (MRI) and was suspected to be caused by Prevotella intermedia. It was further confirmed that it was a secondary infection from the oral cavity, and the possible etiology might have been dental surgery. Treatment was rendered to the patient based on metagenomic test result, and her condition improved after two months. Conclusions: This case highlights the role of mNGS in accurate diagnosis of patients with central nervous system infection. In particular, mNGS can be used to identify rare pathogens and confirm the diagnosis in patients with unknown etiology. [ABSTRACT FROM AUTHOR]

Objective This study aims to establish a nomogram model for predicting the risk of postoperative intracranial infection in patients with severe neurological diseases. Methods A retrospective study was conducted on clinical data from 200 patients who underwent surgical treatment in our hospital’s neurosurgical care unit between January 2018 and January 2021. The patients were randomly divided into a training set(n=140)and a validation set(n=60). Univariate analysis and multivariate logistic regression analysis were used to screen the risk factors，constructing the prediction model by nomogram. The receiver operating characteristic (ROC) curve was plotted to assess the predictive efficacy of the nomogram model for intracranial infection in patients with severe neurological diseases. Additionally，validation of the model and evaluation of its clinical net benefit were performed using decision curve analysis(DCA). Results The protopathy，external ventricular drainage time and lumbar cisterna drainage time were the risk factors for postoperative intracranial infection(P < 0.05). ROC curve of the nomogram model showed that the area under curve(AUC) of the training set and the validation set were 0.774(95% CI 0.695~0.853)and 0.831(95% CI 0.725~0.936)，respectively. DCA curves showed that the prediction of intracranial infection could improve the clinical benefit rate. Conclusion: Our nomogram prediction model based on risk factors associated with postoperative intracranial infection in patients with severe neurological diseases offers an effective approach for early identification of high⁃risk individuals facilitating prompt diagnosis and treatment while improving the prognosis of patients. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine risk factors of pejorative evolution course in patients suffering from postoperative cranial infection. The data of patients who developed an intracranial infection after craniocerebral surgery in the neurosurgical intensive care unit of the First Affiliated Hospital of Nanjing Medical University in Nanjing, Jiangsu, China, from February 2018 to August 2019 were retrospectively analyzed. Logistic regression was used to analyze the factors influencing the prognosis of intracranial infection treatment. Sixty-four patients developed an infection after craniocerebral surgery, and 48 of them with negative CSF cultures received experimental anti-infectives. In 16 patients, cerebrospinal fluid culture showed pandrug-resistant pathogens, including 11 Acinetobacter baumannii (11), Klebsiella pneumoniae (3), Escherichia coli (1), and Candida glabrata (1). Nine patients received intraventricular or intrathecal injections of polymyxin B. The mean duration of infection treatment was 22.2 ± 9.9 days, and the clinical cure rate was 85.9% (55/64). Logistic multivariate regression analysis showed that inadequate CSF drainage (OR, 6.839; 95% CI, 1.130–41.383; P = 0.036) and infection with drug-resistant bacteria (OR, 24.241; 95% CI, 2.032–289.150; P = 0.012) were independent risk factors for postoperative intracranial infection. Intracranial infection with positive CSF culture and inadequate CSF drainage are factors contributing to the poor prognosis of intracranial infection. Moreover, early anti-infection treatment and adequate CSF drainage may improve patient outcomes. In particular, intraventricular or intrathecal injection of polymyxin B may be a safe and effective treatment strategy for MDR/XDR gram-negative bacilli infection. [ABSTRACT FROM AUTHOR]

To investigate the value of CD64 in the early diagnosis of intracranial infection after craniocerebral surgery. A total of 93 patients who met the inclusion and exclusion criteria after neurosurgery in Lianyungang First People's Hospital and Lianyungang Second People's Hospital were admitted and divided into experimental group with intracranial infection (n = 32) and uninfected control group (n = 61) according to the results of cerebrospinal fluid culture. We performed relevant statistical analysis, drew the receiver operating characteristic curve and calculated area under the curve (AUC). The sensitivity and specificity of the CD64, c-reactive protein (CRP), and white blood cell (WBC) counts were 84.38% and 86.89%, 78.13% and 75.41%, and 75.00% and 67.21%, respectively; the AUCs were 0.912, 0.858, and 0.851, respectively. Accuracy was the highest when the 3 diagnosis were combined, reaching 93.75%; the AUC could reach 0.948. Serum CD64, CRP, and WBC count in the diagnosis of intracranial infection after craniocerebral surgery were significant. CD64 was more valuable than the others. The diagnostic efficiency could be improved when CD64, CRP, and WBC count were combined. [ABSTRACT FROM AUTHOR]

To establish and verify the prediction model of intracranial infection after minimally invasive puncture drainage for hypertensive intracerebral hemorrhage (HICH) based on clinical data. Methods A total of 231 patients with HICH treated by minimally invasive puncture drainage were included. According to postoperative intracranial infection occurrence, patients were divided into infected group and non-infected group. 16 factors that may be associated with intracranial infection after puncture and drainage of HICH were analyzed and compared. The least absolute shrinkage and selection operator (LASSO) regression was used to practice features selection and discover predictors. The multivariate logistic regression was used to establish the prediction model and constructe nomogram. Receiver operating characteristic (ROC) curve and calibration curve were respectively used to detect the discrimination and degree of fitting of the model. Decision curve analysis (DCA) was used to evaluate the clinical applicability of the prediction model. Results Four predictors (double drainage tubes, cerebrospinal fluid leakage, drainage duration, and urokinase injection times) were screened by LASSO regression, which were incorporated into logistic regression and mapped. It has been verified that the area under the curve of ROC was 0.779. The calibration curve showed that the predicted probability was in good agreement with the actual probability. DCA showed the clinical applicability of the model in a certain range. Conclusion The prediction model of intracranial infection after minimally invasive puncture for HICH established in this study has good differentiation, degree of fitting and clinical applicability, which is conducive to the early identification and targeted treatment of high-risk patients with postoperative intracerebral infection [ABSTRACT FROM AUTHOR]

Ling-Zhi Jiang, Ye Shen, Feng Liang, Xiang-Ming Ye, Jing Chen, Yan-Mei Yu Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of ChinaCorrespondence: Xiang-Ming Ye, Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of China, Tel +86-13750814756, Email yexmdr@hotmail.comAbstract: Intracranial infections are the most serious and common postoperative complications with significant mortality and morbidity. Myroides odoratimimus (M. odoratimimus), a Gram-negative environmental species and an opportunistic microorganism, predominantly infects immunocompromised individuals. Limited clinical experiences and documented multidrug resistance have resulted in a scarcity of data on the treatment of M. odoratimimus infections. As far as we know, this is the first reported case of an intracranial M. odoratimimus infection with external ventricular drains (EVD) that was effectively treated with a combination of intravenous and intraventricular tigecycline in an immunocompetent adult host.Keywords: Myroides odoratimimus, M. odoratimimus, intracranial infection, immunocompetent host, tigecycline

Objective To explore the influencing factors of intracranial infection in patients after ventricular drainage, and to build and verify the established risk prediction model. Methods A retrospective analysis was carried out on 757 patients who underwent external ventricular drainage (EVD) in our department from January 2010 to December 2018. According to the occurrence of postoperative intracranial infection, they were divided into intracranial infection group (n=79) and non-intracranial infection group (n=678). Their clinical data were collected and compared. Univariate analysis and multivariate logistic regression analysis were used to explore the influencing factors of intracranial infection after ventricular drainage. A risk prediction model was established and anomogram was drawn. Another 148 patients with EVD in our hospital from 2019 to 2020 were selected as the validation group, including 8 patients with intracranial infection after surgery and 140 patients without. The area under receiver operating characteristic (ROC) curve and Hosmer-Lemeshow test were employed to evaluate the prediction efficacy of the model. Results Hypoproteinemia, lumbar cisternae drainage, EVD time >7 d, pulmonary infection, tracheotomy, open craniocerebral trauma, surgical incision infection, and complicated with bacteremia/sepsis were influencing factors of intracranial infection after EVD. The validation results for the prediction model showed that the area under ROC curve for the risk of postoperative intracranial infection was 0.923 in the modeling group and 0.920 in the verification sample (P < 0.01). As to the Hosmer-Lemeshow test, the P value was 0.450 in the modeling patients and 0.877 in those from the verification group. Conclusion There are 8 high-risk factors for incidence of intracranial infection in patients after EVD. Our established model can effectively predict the occurrence of intracranial infection in these patients.

Background: Intracranial infection by Acinetobacter baumannii (A. baumannii) after neurosurgery has always been a difficult problem for neurosurgeons. This study analyzed risk factors that discriminated A. baumannii from other bacteria causing intracranial infection after neurosurgery. It also examined the differences in the cerebrospinal fluid (CSF) indexes to explore their value in the early diagnosis of intracranial infection by A. baumannii. Methods: We retrospectively reviewed ten years (January 2011 to May 2021) of postoperative central nervous system (CNS) infections in the First Hospital of China Medical University. According to the pathogen, CNS infections were divided into A. baumannii group and other species of bacteria group. We collected clinical and laboratory information of patients, and statistical analysis was performed with SPSS 26.0. Risk factors were screened by univariate analysis, and independent risk factors were screened by multiple logistic regression analysis. Finally, CSF-Pro, CSF-Glu, CSF-Cl, CSF-monocytes (%), CSF-multinucleated cells (%) levels, and CSF multinucleated cells%/monocytes% in the different groups were analyzed. Results: A total of 155 patients were included, 62 cases (40%) of intracranial infection by A. baumannii and 93 cases (60%) by other species of bacteria. The analysis showed that indwelling nasogastric tubes (P＜0.001, OR = 4.231), indwelling peripherally inserted central catheters (PICCs) (P = 0.041, OR = 2.765), and CSF drainage obstruction (P = 0.003, OR = 3.765) were independent risk factors for intracranial infection by A. baumannii after neurosurgery. Indwelling ventriculoperitoneal shunt (VPS) was a protective factor (P = 0.033, OR = 0.22). In addition, compared with other bacterial groups, the A. baumannii group had higher CSF-pro and CSF- multinucleated cells (%) levels and lower CSF-Glu and CSF- monocytes (%) levels, and the difference was statistically significant (P

Objective: To explore the phase-contrast magnetic resonance image (PC-MRI) technology analysis the changes of cerebrospinal fluid hydrodynamics before and after surgery in patients with subtonsillar hernia (Chiari) malformation type I and the influencing factors of postoperative intracranial infection. Methods: In this study, 80 patients with Chiari malformation type I who were admitted to our hospital from January 2019 to January 2022 were selected for study. MRI and PC-MRI examinations were performed on the head and neck of all patients, and cerebrospinal fluid hydrodynamics were analyzed using Q-flow software. The cerebrospinal fluid hydrodynamics indexes of patients with Chiari malformation type I were compared before and after surgery. The difference of clinical features between postoperative intracranial infection and non-intracranial infection in patients with Chiari malformation type Ⅰ were analyzed. Multivariate Logistic regression analysis of the influencing factors of postoperative intracranial infection in patients with Chiari malformation type I. Results: 3 months after surgery, the mean flux (MF), stroke volume (SV) and regurgitant fraction (RF) in the patients with Chiari malformation type I were significantly higher than those at 24 h before surgery, and the maximum peak velocity of foot (Vdmax) and maximum peak velocity of head (Vumax) were significantly lower than those at 24 h before surgery(P<0.05). 3 months after surgery, the ventral pons MF and SV in the patients with Chiari malformation type I were significantly higher than those at 24 h before surgery, and RF, Vdmax and Vumax were significantly lower than those at 24 h before surgery (P<0.05). 3 months after surgery, ventral MF and SV of C3 and RF, Vdmax and Vumax in the patients with Chiari malformation type I were significantly higher than those at 24 h before surgery(P<0.05). Among the patients with Chiari malformation type I, there were 19 cases with intracranial infection after surgery, and 61 cases without infection. Multivariate Logistic regression analysis showed that older age, longer operation time, no use of antibiotics and postoperative spinal fluid leakage were risk factors for postoperative intracranial infection in patients with Chiari malformation type I (P<0.05). Conclusion: PC-MRI can effectively analyze the changes of cerebrospinal fluid hydrodynamics in patients with Chiari malformation type I before and after surgery. Risk factors for postoperative intracranial infection in patients with Chiari malformation type I include older age, longer operation time, no use of antibiotics, and postoperative spinal fluid leakage. [ABSTRACT FROM AUTHOR]

Background: Brain infections (BI) may cause optic nerve abnormalities. Awareness on optic nerve abnormalities will be useful in assisting further management. The characteristics of the ocular fundus (fundus) in BI have not been widely studied in Indonesia. This study aimed to apprehend the depiction of the fundus in BI in Cipto Mangunkusumo Hospital Jakarta (RSCM). Methods: Cross-sectional study was conducted on October-December 2021 at RSCM. Inclusion criteria: BI patients who had fundas results. Exclusion criteria: fundas results cannot be interpreted. Images from 20D-lens fundoscopy were captured with a digital camera. Captured images were then interpreted by three examiners in disguise. Results are analyzed if there are similarities between at least two examiners. Results: There were 49 subjects whose fundoscopy results could be analyzed. A total of 25 subjects has normal fundus. Abnormalities were seen in 8 subjects, which comprised of 4 (12.1%) papilledema, 3 (9.1%) papillatrophy and 1 (3%) retinal haemorrhage. The highest mean aperture pressure was found in the papillatrophy group (37cmH2O), followed by papilledema (27cmH2O). BI that often causes papilledema (60%) is cryptococcal meningitis. Of all BI that ended up with mortality, 80% were tuberculous meningitis with normal fundus on examination. Discussion: BI can increase intracranial pressure (ICP). Nonetheless, we found only 12.1% had papilledema. The highest mean aperture pressure was found in the papillatrophy group which showed an increase in ICP over a long period of time. The highest mortality was found in the normal fundus group so that papilledema cannot be directly associated with a worse prognosis considering the uncontrolled confounding factors such as other BI complications. Conclusion: Although BI causes an increase in ICP, papilledema is not always found. High aperture pressure was found in the papillatrophy group, but the highest mortality was found in the normal fundus group. [ABSTRACT FROM AUTHOR]

Objective To investigate the diagnosis and treatment of isolated fourth ventricle after intracranial infection. Methods The clinical data of 4 patients with isolated fourth ventricle admitted to the Department of Neurosurgery, General Aviation Hospital from February 2018 to January 2020 were retrospectively analyzed, and the relevant literature was reviewed. Results Four cases of isolated fourth ventricle were all secondary to intracranial infection, and all had undergone lateral ventricular drainage. The clinical manifestations were coma, delayed pupillary light reflex, shallow and rapid respiration, fluctuating heart rate and blood pressure, dysphagia, salivation, increased muscle tone, and presence of denervation and rigidity. Two cases needed a breathing machine to assist with respiration, and norepinephrine was used to maintain blood pressure. Among them, 2 patients underwent endoscopic exploration and showed the formation of pus coating and pseudomembranous separation in the fourth ventricle. All 4 patients underwent external drainage from the fourth ventricle to the abdominal wall. Among them, 1 patient underwent simultaneous drainage from the annular cistern cyst to the abdominal wall, and 1 patient complicated with spinal cord subarachnoid abscess and soft tissue suppurative infection in the craniotomy area underwent simultaneous drainage from the pus cavity, epidural drainage, and lumbar cistern drainage. During extracorporeal drainage, intracranial infection was treated with drainage and irrigation. After surgery, the pupil reflex, respiration, blood pressure, salivation, gastroparesis, muscle tone, and denervation rigidity of the patient were significantly improved. Both vasopressor drugs and ventilator therapy were discontinued. One patient was awake after surgery, and three patients were still in a coma state (including two patients with severe bilateral cerebral hemisphere and midbrain injury). After the intracranial infection was cured, a ventriculoperitoneal shunt was performed, with 2 patients using a shunt pump (30 mmH₂O) and 2 patients not using a shunt pump, using a straight tube for shunt. Conclusions For patients with intracranial infection and isolated hydrocephalus of the fourth ventricle, if diagnosed by imaging and accompanied by corresponding clinical symptoms, early surgery should be performed to relieve the compression of the fourth ventricle on the brainstem, which is very important to improve the prognosis of patients. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the characteristics of intracranial infection (ICI) in patients after neurosurgery, and the influence of rational use of antibiotics. Methods: The medical records of 127 patients with neurosurgery-related ICI who were admitted into Jincheng People's Hospital, Jincheng, Shanxi, China from April 2019 to April 2022 were selected. The results of bacterial culture and drug susceptibility tests of cerebrospinal fluid were collected, and the profile of bacteria in the cerebrospinal fluid specimens of patients and the different bacterial compositions were analyzed. Results: A total of 148 strains of pathogenic bacteria were cultured and isolated from the cerebrospinal fluid samples of 127 patients, out of which 91 strains of Gram-positive bacteria accounted for 61.49 %, and 57 strains of Gram-negative bacteria accounted for 38.51 %. The Gram-positive bacteria were Staphylococcus aureus, coagulase-negative Staphylococcus, and hemolytic Staphylococcus, while the Gram-negative bacteria comprised the pathogenic bacteria Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa. The Gram-positive bacteria were more sensitive to rifampicin (91.21 %), vancomycin (95.60 %), and linezolid (97.80 %), while the Gram-negative bacteria were more sensitive to imipenem (84.21 %), meropenem (75.44 %) and amikacin (77.19 %). Conclusion: Gram-positive bacteria are the main pathogenic bacteria implicated in ICI after neurosurgery in patients. A further large-scale study is needed for better delineation of the disease presentation and prognosis. [ABSTRACT FROM AUTHOR]

Introduction: Haemophilus influenzae (Hi) is subdivided into typeable (a–f) and non‐typeable groups. Hi serotype b (Hib) has historically been one of the important pathogens responsible for invasive infection. However, after widespread Hib vaccination, the emergence of other Hi serotypes, specifically Hi serotype a (Hia), was noted during the last few decades, mostly in children younger than 5 years of age. Case presentation: We present two cases of severe intracranial infections with detected Hia in patients > 5 years of age within a short time frame and within the same geographic area. Conclusion: Epidemiological studies and surveillance on Hia‐related illnesses in all age groups worldwide are needed to better understand the clinical and epidemiological characteristics of Hia. This can establish a platform to develop a candidate vaccine against Hia that might protect children of all ages. [ABSTRACT FROM AUTHOR]

The cerebrospinal fluid (CSF) analysis in ruptured aneurysms can be greatly affected by subarachnoid hemorrhage (SAH), making the diagnosis of intracranial infection more difficult after surgery. This study aimed to identify the reference value range of CSF in the pathological state following spontaneous SAH. A retrospective analysis of demographic and CSF data of all spontaneous SAH patients treated between January 2018 and January 2023 was conducted. A total of 101 valid CSF specimen data were collected for analysis. Our results indicate that in 95% of patients after spontaneous SAH, the leukocyte count in CSF was less than 880 × 106/L. Additionally, the proportion of neutrophils, lymphocytes, and monocytes did not exceed 75%, 75%, and 15%, respectively, in 95% of the population. Furthermore, in 95% of the specimens, the concentration of chloride, glucose, and protein was >115 mmol/L, >2.2 mmol/L, and <2.3 g/L, respectively. Compared to the normal reference values, the CSF indexes after spontaneous SAH showed significant changes, especially in the leukocyte count, chloride concentration, and glucose concentration. Using "white blood cell count < 880/mm3, glucose > 2.2 mmol/L, chloride > 115" as the reference values for SAH pathological status is more meaningful for reference purposes. [ABSTRACT FROM AUTHOR]

Abstract Background Intracranial abscesses are rare but serious, and are associated with significant morbidity and mortality. Due to both the rarity and severity of these infections, well-controlled trials have not been reported in the literature, and optimal management is a matter for expert opinion. Advances in surgical management have improved outcomes and increased rates of microbiological diagnosis. However, the approach to antimicrobial chemotherapy varies considerably, including the choice of antibiotic, the duration of treatment, and the timing of oral switch. Methods We conducted a retrospective review of 43 cases of intracranial abscesses from a large, tertiary neurosurgical centre in London, UK, between 2018 and 2020, including 29 primary intra-parenchymal abscesses, 11 subdural abscesses and 3 extradural abscesses. Results The majority of cases had surgical intervention; 6/43 (14%) required repeat intervention (all intra-parenchymal abscesses). A microbiological diagnosis was made in 83% of cases. Intravenous antibiotics were given for a median of 33 days (IQR 23–44 days), with a variable duration of oral follow-on antibiotics. Total duration of antibiotic treatment ranged from 0 to 467 days. Only three patients from our cohort are known to have died. Conclusion Shorter courses of intravenous antibiotics for brain abscesses were not associated with increased mortality. In the absence of well-controlled trials, a national registry of intracranial abscesses would provide invaluable data to inform optimal treatment.

Min Zhou, Richu Liang, Quan Liao, Pingfu Deng, Wentao Fan, Chenzhuo Li The Second affiliated Hospital, Department of Neurosurgery, Hengyang Medical School, University of South China, Hengyang, 421001, People’s Republic of ChinaCorrespondence: Richu Liang, The Second AFfiliated Hospital, Department of Neurosurgery, Hengyang Medical School, University of South China, Hengyang, 421001, People’s Republic of China, Email 2015020049@usc.edu.cnBackground: Intracranial infection is a common complication caused by craniotomy. In particular, patients in Intensive Care Units (ICU) are prone to intracranial infection with multiple drug-resistant bacteria. Due to the lack of sensitive antibiotics for the treatment of multiple drug-resistant bacteria, there are few literatures focusing on the treatment of intracranial infection, and patients often fail to receive unified and standardized treatment. Consequently, patients with Carbapenem-resistant bacteria intracranial infection report poor prognosis and high mortality. It is very important to discuss how to treat patients with intracranial infection caused by multidrug resistant bacteria.Case Presentation: We reported a case of intracranial infection of Carbapenem-resistant Klebsiella pneumoniae(CRKp) due to high flap tension, poor wound healing and CSF leakage caused by subcutaneous fluid accumulation after intracerebral hemorrhage craniotomy. Since the patient was exposed to intracranial infection resulted from subcutaneous fluid accumulation, we adopted the method of continuous drainage with subcutaneous tube. When subcutaneous effusion disappeared, the subcutaneous drainage tube was pull out, while patients exhibited high fever again, the waist big pool drainage catheter and continuous drainage were carried out. According to the result of Subcutaneous effusion and CSF culture indicated multiple drug resistant Klebsiella pneumoniae intracranial infection and drug susceptibility, The treatment of gentamicin intrathecal injection, intravenous use amikacin and oral Paediatric Compound Sulfamethoxazole Tablets was adopted, the condition of intracranial infection was eventually controlled, with the consciousness restored. This patient was characterized by intracranial infection with Carbapenem-resistant Klebsiella pneumoniae(CRKp).Conclusions: Subcutaneous effusion is a high-risk factor for poor wound healing and interventions are required to be conducted to promote healing as early as possible to contribute to decreasing the menace of CSF leakage. In this case, Continuous drainage and intrathecal injection of sensitive antibiotics serve as critical process to determine the best strategy for clinical treatment of intracranial infection.Keywords: intracranial infection, carbapenem-resistant Klebsiella pneumoniae, lumbar cistern drainage, intrathecal injection, gentamicin