limingqiangdao ：To @Professor Li Xiaoyong
Question: Professor Li, a patient had fever (up to 39.5℃), neck resistance, headache, cloudy cerebrospinal fluid 5 days after cranial conotomy, two cerebrospinal fluid cultures and one sputum culture showed Staphylococcus haemolyticus (both MRSE), with desmethylvancomycin 0.8g
The drug was administered with norethindrubicin 0.8g q12h ivgtt, rifampicin 0.6g qd po, intrathecal vancomycin 20mg
qd, using drugs for a week, 37.5-38.5 ℃, headache and neck resistance is not significantly improved, the effect is not good reason? Prof. Li Xiaoyong：
First of all, I don’t know why you want to have cranial cone surgery? Is it already intracranial hypertension or hemorrhage or something else, which is crucial: is the intracranial infection a disease before the cone hole or is it an infection caused by your cone hole? If you are drilling for high cranial pressure, there may be residual unsatisfactory control of intracranial pressure even after the infection is controlled, or your patient may have a serious infection: a parenchymal infection or intracerebroventricular adhesion infection, or another bacterial infection of some kind, all of which should be taken very seriously. Ginkgokeer: to @Prof. Li Xiaoyong
Q: ①In clinical practice, the cerebrospinal fluid leukocytes and sugar have been normalized in children with chemobrain, but the protein is high, is there a standard for cerebrospinal fluid protein in children of different ages? ②What are the indications for dural puncture fluid puncture? ③If a child with chemoencephalitis has hearing impairment, is vancomycin available? Prof. Li Xiaoyong
I can’t give you a direct answer to the question about whether there are standards for cerebrospinal fluid proteins in children of different ages because I don’t have a specific study, but according to my clinical experience, there should not be any difference because there should not be abnormal levels of proteins in normal cerebrospinal fluid. In the past two years, I always feel that there must be infectious or non-infectious proteins in infected and non-infected cerebrospinal fluid, and I have worked with the Protein Research Laboratory of the Institute of Biological Sciences of the Chinese Academy of Sciences to determine the types of proteins, but the reality is that there are more than 400 proteins, and finding the proteins I want to find from them is an impossible task in terms of practicality, funding and personnel. I hope that in the future, when the cerebrospinal fluid department has developed to a certain extent, someone will do this work. Vancomycin is used for anti-infection. According to my clinical observation, there is no case of hearing impairment in children, so it should not be a problem to use it for chemical brain treatment. As for the question of indications for dural puncture, it is a difficult question to answer, do you intend to use it for diagnosis or treatment? If there is clinical suspicion of intracranial infection, do it directly, if you think there is intracranial hypertension, just puncture it directly, it is not a problem for neurosurgeons or neurologists. Summer0 : Question for @Prof. Li Xiaoyong: What is the positive culture rate of your infections? What are your clinical criteria for diagnosing intracranial infections? Prof. Li Xiaoyong : I don’t know what you mean by culture.
I don’t know if you are referring to cerebrospinal fluid or blood cultures? There are no recent studies on cerebrospinal fluid bacterial cultures, because the vast majority of cases we receive are from outside hospitals and those transferred from overseas that have been infected for a long time and are severe, so they are not as representative as those from general hospitals. My criteria for infection, which may indeed be different from the domestic literature and the vast majority of experts, are a combination of test and clinical criteria. This is because a proportion of infected cases with clinical manifestations related to the use of anti-infective treatment in the presence of negative existing tests ended up with good treatment results. With the current criteria, there are still many errors that need further study, such as some of the severe intracranial infections I mentioned, whose cerebrospinal fluid may be or has been treated to normal, but bacteria are still present in the brain parenchyma.