Efficacy of intravenous plus intrathecal/intracerebral ventricle injection of tigecycline for post‑neurosurgical intracranial infections due to MDR/XDR <i>Acinetobacter baumannii</i>: A retrospective cohort study

Intracranial infection is a complication of neurosurgery that can lead to severe neurological complications, greatly increasing the risk of mortality. Intracranial infection caused by multidrug-resistant <i>Acinetobacter baumannii</i> (MDR-AB) is one of the most severe complications of craniotomy. However, the availability of effective therapeutic options for such infections remains limited. Therefore, the present study aimed to assess the therapeutic efficacy of intrathecal/intracerebral (ITC) ventricle tigecycline injection for managing post-neurosurgical intracranial infections caused by MDR-AB. The present retrospective study was conducted from January 2014 to December 2023 at the Second Affiliated Hospital of Shandong First Medical University (Taian, China), which included 15 cases of MDR-AB positivity in the cerebrospinal fluid (CSF) cultures after neurosurgery. Patients treated with intravenous and intrathecal/ITC tigecycline ventricle injection were assigned to the 'ITV + ITC' group, whereas patients treated without intrathecal/ITC injection were assigned to the 'ITV' group. Data for general information, treatment history, the results of biochemical indicators in CSF and the microbiological clearance rate were collected and analyzed. No significant differences were observed in characteristics, susceptibility testing or empirical antimicrobial use between the two groups after treatment. However, after treatment, the ITV + ITC group exhibited a significantly decreased body temperature, whilst the biochemical indicators present in CSF were significantly improved. In addition, the ITV + ITC group had a significantly higher microbiological clearance rate (5/6; 83.33%) compared with that in the ITV group (2/9; 22.22%). These findings suggest that intravenous plus intrathecal/ITC ventricle injection of tigecycline is an effective regimen for treating intracranial infections caused by MDR-AB.