Treatment of postoperative MRSA intracranial infection with intraventricular vancomycin

LI Qing-gang; CHENG Gang; SUN Jun-zhao; ZHANG Jian-ning; LIU Ru-en

doi:10.13798/j.issn.1009-153X.2025.03.003

Abstract：Objective To investigate the efficacy and safety of intraventricular vancomycin administration in the treatment of methicillin-resistant Staphylococcus aureus(MRSA)-induced intracranial infection following craniotomy.Methods A retrospective analysis was conducted on 54 patients with MRSA-induced intracranial infection after craniotomy,admitted between February 2018 and December 2020.The control group(26 patients)received systemic intravenous vancomycin alone(1 000 mg every 12 hours),while the observation group(28 patients)received additional intraventricular vancomycin via an external ventricular drain(10 ml of normal saline containing 25 mg vancomycin,followed by 2-hour clamping of the catheter,administered 1～2 times daily depending on infection severity).Results The cure rate in the observation group was significantly higher than that in the control group(85.7%vs.38.5%;P<0.001).Within 1～5 days of treatment,the reduction rate of cerebrospinal fluid white blood cell count in the observation group was significantly greater compared to the control group(P<0.05).The infection control time and symptom relief time were also significantly shorter in the observation group(P<0.05).No adverse reactions,such as tinnitus,hearing loss,vertigo,seizures,hepatotoxicity,nephrotoxicity,diarrhea,or hematologic toxicity,were observed in the observation group.Conclusion For MRSA-induced intracranial infection following craniotomy,intraventricular vancomycin administration combined with systemic intravenous therapy significantly enhances therapeutic efficacy and demonstrates favorable safety and tolerability.