An outbreak of hemodialysis catheter-related bacteremia with sepsis caused by Streptococcus agalactiae in a hemodialysis unit

BackgroundRates of invasive group B Streptococcus (GBS; Streptococcus agalactiae) disease in adults are on the rise. Invasive GBS disease can be community- or healthcare-associated. We report an outbreak of GBS catheter-related bacteremia in a hemodialysis (HD) unit.Materials and methodsTwo patients undergoing HD at the same outpatient HD unit were admitted on the same day (within a few hours of each other) with catheter-related GBS bacteremia. A retrospective study was undertaken at the HD unit to address risk factors for febrile illness on the last HD session day. A detailed questionnaire was completed by all HD patients treated on the same day as the two GBS patients and by all members of the nursing and medical staff. Medical and nursing records of the HD unit were reviewed, as well as infection control and catheter care practices. Patients and staff members submitted swabs for culture.ResultsNo rectal or vaginal culture of any HD patient or staff member was positive for GBS. The development of recent febrile disease was significantly associated with the presence of a hemodialysis catheter (p = 0.028) and care for more than 30 min by a specific nurse during the last two HD sessions (p = 0.007).ConclusionsWe speculate that the GBS strain was transmitted from one patient to the other through the hands of medical personnel. No such outbreak has ever been reported in HD patients. The importance of strict infection control practices in HD units and the avoidance of catheters for long-term HD should be emphasized.     

Clinical significance of Candida species isolated from cerebrospinal fluid following neurosurgery.

Twenty-one patients for whom adequate clinical data were available were identified in a retrospective review of cases of Candida species isolated from cerebrospinal fluid (CSF) following neurosurgery; 86% had indwelling cerebrospinal devices (shunts). Candida species were isolated from multiple CSF samples from 10 patients; CSF samples from seven of 10 were initially drawn through indwelling devices and those from nine of 10 were obtained by subsequent lumbar punctures. All of these patients were treated with antifungals, although therapy was delayed in 50% of cases until the second positive culture was reported. In 11 cases, Candida was the only isolate recovered from CSF samples drawn through indwelling devices; cultures of subsequent CSF samples obtained by lumbar puncture were negative in 10 of 11 cases. Only two patients for whom a single culture was positive for Candida species were treated with antifungals (both of whom were symptomatic), and none of the untreated patients died of infection. The clinical significance of a single positive CSF sample drawn through an indwelling device is difficult to assess, and a definitive diagnosis may require repeated cultures of CSF samples obtained by lumbar puncture.     

Multiple intensive care unit outbreak of Acinetobacter calcoaceticus subspecies anitratus respiratory infection and colonization associated with contaminated, reusable ventilator circuits and resuscitation bags

PURPOSE: Acinetobacter calcoaceticus subspecies anitratus (A. anitratus) can cause nosocomially and community acquired pneumonia. Source identification of the organism is often difficult. An outbreak of respiratory infection and colonization with A. anitratus affecting 93 ventilated patients in all six of a hospital's intensive care units (ICUs) over 10 months is described. PATIENTS AND METHODS: In April 1984, the infection control staff started to review positive culture results from all patients in all ICUs. At this point, information on significant isolates was recorded by patient, site, date, genus and species, and antimicrobial susceptibility. During the month of August 1984, an increased number of A. anitratus isolates from sputum began to be detected. Information was expanded to include the date of hospital admission, ICU admission, intubation, and extubation; the dates and types of all surgical procedures; the results and dates of all prior sputum cultures; and the use of nebulized bronchodilator medications. Monthly numbers of cases were compared for four months prior to the outbreak, during the outbreak, and for seven months after the outbreak. Plasmid DNA from isolates was prepared, electrophoresed, and visualized. Isolates were designated according to the molecular weights of visualized plasmids. RESULTS: Barrier precautions and improved staff handwashing did not diminish the frequency of new cases. When pasteurized, reusable ventilator circuits and resuscitation bags were cultured for the possibility of low-level contamination, 18 percent were positive for A. anitratus. Terminal ethylene oxide sterilization of these devices was associated with prompt control of the outbreak. Plasmid DNA analysis of isolates from patients involved in the outbreak, contaminated devices, and the hands of personnel responsible for device disinfection revealed two predominant plasmid profiles. After outbreak control, isolates with these profiles were found much less frequently in patient specimens. CONCLUSION: Contaminated, reusable ventilator support equipment may be a leading cause for the extent of A. anitratus in the sputum of intubated patients. This problem is potentially correctable by the use of terminal etyhlene oxide sterilization of reusable ventilator circuits and resuscitation bags.     

An accurate method to obtain urine for culture in men with external catheters

Results of urine cultures from 26 male nursing home patients wearing external catheters, collected by a simple standardized technique, were compared with culture results from the same patients obtained by sterile in-and-out catheterization. The culture results were the same in 22 (85%) of the matched specimens, and specimens collected by the standardized technique were 100% sensitive and 94% specific in detecting significant growth of pathogenic organisms. In contrast, 13 (57%) of 23 specimens collected from patients with external catheters by the nursing home staff using their routine technique yielded three or more organisms and were considered contaminated. These results suggest that it is possible to obtain a urine specimen that reflects bladder urine in the vast majority of patients with external catheters, and thus potentially avoid the need for in-and-out catheterization when diagnosing and planning treatment for urinary tract infections in this population.     

Ventriculostomy-associated infections: incidence and risk factors

BACKGROUND: The objective of this study was to assess the incidence of ventriculostomy-associated infections (VAI) and to examine the related risk factors. METHODS: Data on all consecutive patients with ventriculostomy catheters admitted to the intensive care unit (ICU) in a tertiary care center over a 3-year period were identified from the ICU database and from medical records. VAI was documented using a preset definition. The following patient data were documented: demographics, severity of illness measures, indication for the catheter, presence of cerebrospinal fluid (CSF) leak, and length of stay and mortality. The following catheter data were collected: venue of catheter placement (operating room or nonoperating room areas), use of antibiotic irrigation and prophylactic systemic antibiotics, and number of catheter days. The frequency of CSF sampling was documented. RESULTS: In 84 patients, 99 catheters were placed, of which 19% developed VAI. There was a total of 586 catheter days (infection rate, 32 per 1000 catheter days). The risk of VAI increased steadily until catheter day 7 then reached a plateau. Among patients' factors, repeat catheter insertion was associated with a significant increase in VAI. There were no significant associations with age, severity of illness, indication for the catheter, craniatomy, or presence of CSF leak. Among catheter factors, the number of catheter days and repeat catheter insertion emerged as significant independent predictors on multivariate analysis. Placement outside the operating room was associated with a trend toward higher VAI. The use of prophylactic antibiotic or antibiotic irrigation did not significantly alter VAI rates. Routine surveillance cultures of CSF were no more likely to detect infection than cultures obtained when clinically indicated. Gram-negative bacilli were responsible for 50% of the infections, followed by gram-positive cocci (29%) and others (21%). CONCLUSIONS: The risk of VAI increases with increasing duration of catheterization and with repeated insertions. The use of local antibiotic irrigation or systemic antibiotics does not appear to reduce the risk of VAI. Routine surveillance cultures of CSF were no more likely to detect infection than cultures obtained when clinically indicated. These findings need to be considered in infection control policies addressing this important issue.     

Successful treatment of vancomycin-resistant Enterococcus faecium meningitis with linezolid: case report and literature review.

Vancomycin-resistant enterococci (VRE) are a rare cause of meningitis, occurring primarily in patients who have undergone neurosurgical procedures. We describe the first reported case of VRE meningitis successfully treated with linezolid. A 56-y-old female with subarachnoid hemorrhage underwent ventriculostomy and embolization of cerebral aneurysms. Her postoperative course was complicated by multiple infections needing repeated antibiotic courses, culminating in the development of VRE meningitis. She was treated with 600 mg of i.v. linezolid (MIC < 0.75 microg/ml) every 12 h for 6 weeks. After the fourth dose, peak and trough linezolid concentrations were 11.45 and 0.14 microg/ml in serum and 3.19 and 2.39 microg/ml in cerebral spinal fluid (CSF). On Day 19 of linezolid therapy, serum and CSF trough concentrations were 1.53 and 2.98 microg/ml, respectively. Linezolid achieved sufficient CSF concentrations to bring about clinical and bacteriological cure. We conclude that i.v. linezolid may be a useful option for treating VRE meningitis. We also present findings of a literature review, which identified 11 cases of VRE meningitis treated with other pharmacologic agents with mixed success.     

An outbreak of influenza A (H3N2) in a well immunized nursing home population.

OBJECTIVE: To describe the epidemiologic features of an outbreak of influenza A that occurred in a skilled nursing home although over 90 percent of the resident population had previously received influenza vaccine. DESIGN: Retrospective cohort study. SETTING: Skilled nursing home facility in western New York State. PATIENTS: Nursing home residents and patient-care staff. MAIN OUTCOME MEASURE: Incidence of influenza-like illness among vaccinated versus unvaccinated nursing home residents and staff. RESULTS: Thirty-seven of 124 residents (attack rate = 30%) and 18 of 146 staff (attack rate = 12%) had an influenza-like illness. Staff illness began 16 days prior to onset among residents. Six cases of pneumonia and three influenza-related deaths occurred, all among the vaccinated residents. Ninety percent of the nursing home residents and 10% of the staff received the influenza vaccine prior to the outbreak. The calculated vaccine efficacies were minus 21% and plus 45% for residents and staff, respectively. CONCLUSION: While antigenic drift of the circulating influenza virus was the major factor in the apparent vaccine failure, the observed poor staff immunization rate (10%) and absence of surveillance which precluded the use of amantadine chemoprophylaxis suggest that the use of these strategies may be of importance in controlling influenza outbreaks in nursing homes.     

Risk factors and prognostic indicators of bacterial meningitis in a cohort of 3580 postneurosurgical patients

In order to identify the incidence, risk factors and prognostic indicators of postneurosurgical bacterial meningitis, a 9-y retrospective cohort study was performed. The cohort comprised 3580 individuals who underwent neurosurgical operations at the Department of Neurosurgery of Catholic University, Rome, a 1,700-bed university hospital. We observed 52 episodes of postneurosurgical meningitis, with infection rates of 1.4/100 patients, 0.8/100 operations for craniotomies and 2.6/100 operations for internal cerebrospinal fluid (CSF) shunt or ventriculostomy with external drainage. The overall infection rate decreased from 2.5/100 operations in 1989 to 0.9/100 in 1997 (p = 0.03). Logistic regression analysis indicated that duration of ventriculostomy with external drainage [p < 0.01; odds ratio (OR) = 9.67; 95% confidence interval (CI) = 2.44-38.321 and increasing value of the APACHE III score (p <0.01; OR = 8.51; 95% CI = 2.15-33.68) were independent risk factors for development of meningitis. The overall case fatality rate was 8%. Predictors of mortality were low ( < 1.66 mmol/l) CSF glucose concentration (p = 0.001), increasing value of the APACHE IIl score (p = 0.002) and Gram-negative aetiology (p = 0.003).     

Update on the treatment of cerebral aspergillosis

In aspergillus infections of the central nervous system (CNS) the mortality risk usually exceeds 90%. Data from case-reports and a recent retrospective study suggest that neurosurgical interventions, such as abscess resections, stereotactic drainages, or the use of intraventricular catheters, might improve the outcome in CNS aspergillosis. However, there is a lack of clear evidence supporting an extensive neurosurgical management in these patients. A major reason for the devastating prognosis in CNS aspergillosis is a poor penetration of antifungal drugs into the CNS, with the exception of voriconazole. Treatment with voriconazole results in measurable drug levels in the cerebrospinal fluid, which may exceed the minimal inhibitory concentration for aspergillus. Moreover, voriconazole brain tissue levels exceed those measured for other antifungal drugs. In a recent retrospective study, a complete or partial response occurred in 35% of patients who were treated with voriconazole for CNS aspergillosis with a survival rate of 31%. These data support the use of voriconazole in this clinical setting. An intense neurosurgical management and higher doses of voriconazole might further improve the outcome in CNS aspergillosis, but this needs to be evaluated in future studies.     

Prevention of intravascular catheter-related infections

PURPOSE: To review the literature on prevention of intravascular catheter-related infections. DATA SOURCES: The MEDLINE database, conference proceedings, and bibliographies of review articles and book chapters were searched for relevant articles. Primary authors were contacted directly if data were incomplete. STUDY SELECTION: Studies met the following criteria unless otherwise stated: Trials were prospective and randomized; catheters were inserted into new sites, not into old sites over guidewires; catheter cultures were done by using semi-quantitative or quantitative methods; and, for prospective studies, catheter-related bloodstream infection was confirmed by microbial growth from percutaneously drawn blood cultures that matched catheter cultures. DATA EXTRACTION: Data on population, methods, preventive strategy, and outcome (measured as catheter-related bloodstream infections) were gathered. The quality of the data was graded by using preestablished criteria. DATA SYNTHESIS: The recommended preventive strategies with the strongest supportive evidence are full barrier precautions during central venous catheter insertion; subcutaneous tunneling short-term catheters inserted in the internal jugular or femoral veins when catheters are not used for drawing blood; contamination shields for pulmonary artery catheters; povidone-iodine ointment applied to insertion sites of hemodialysis catheters; specialized nursing teams caring for patients with short-term peripheral venous catheters, especially at institutions with a high incidence of catheter-related infection; no routine replacement of central venous catheters; antiseptic chamberfilled hub or hub-protective antiseptic sponge for central venous catheters; and use of chlorhexidine-silver sulfadiazine-impregnated or minocycline-rifampin-impregnated short-term central venous catheters if the rate of infection is high despite adherence to other strategies that do not incorporate antimicrobial agents (for example, maximal barrier precautions). CONCLUSIONS: Simple interventions can reduce the risk for serious catheter-related infection. Adequately powered randomized trials are needed.     

Bacillus cereus bacteremia and meningitis in immunocompromised children.

Two cases of Bacillus cereus meningitis in immunocompromised children at our hospital within a 2-month period prompted us to review B. cereus--related invasive disease. We identified 12 patients with B. cereus isolated in blood cultures from September 1988 through August 2000 at our institution. Three of these patients also had B. cereus isolated from CSF specimens; 1 additional patient had possible CNS involvement (33%, group A), whereas 8 patients had no evidence of CNS involvement (67%, group B). Patients in group A were more likely to have neutropenia at the onset of sepsis and were more likely to have an unfavorable outcome. They were also more likely to have received intrathecal chemotherapy in the week before the onset of their illness. Two patients from group A died. One survived with severe sequelae. The fourth patient had mild sequelae at follow-up. No sequelae or deaths occurred among patients in group B. In patients with unfavorable outcomes, the interval from the time of recognition of illness to irreversible damage or death was short, which demonstrates a need for increased awareness, early diagnosis, and more-effective therapy, particularly that which addresses B. cereus toxins.     

Urinary catheters: what type do men and their nurses prefer?

OBJECTIVES: Urinary catheters are used frequently, but the relative risks and benefits of different types of devices are not clear. We sought to determine the beliefs of both older male patients and nursing staff about the relative merits and problems of condom and indwelling catheters. DESIGN: Patient and nurse survey using convenience sampling. SETTING: A University-affiliated Veterans Affairs medical center. PARTICIPANTS: Men hospitalized on medical, rehabilitation and nursing home units using either an indwelling or a condom catheter were invited to participate as were all members of the nursing staff on these units. Of 116 eligible patients, 104 were interviewed (response rate = 90%). Of 107 eligible nursing staff members, 99 completed the questionnaires (response rate = 92%). INTERVENTION AND MEASUREMENTS: Consenting patients were interviewed personally about their urinary catheter. The nursing staff were asked to complete a self-administered questionnaire. RESULTS: Patients were mostly older and predominantly hospitalized on the medical service. Compared with those using an indwelling catheter, patients using a condom catheter were more likely to believe that their catheter was comfortable (86 vs 58%, P = .04) and less likely to believe it was painful (14 vs 48%, P = .008) or to restrict their activity (24 vs 61%, P = .002). The nursing staff had a mean of 13 years nursing experience, and the majority worked in the nursing home unit. Most of the nursing staff respondents believed that condom catheters were less painful and restrictive for patients and were easier to apply, but they also believed that they fell off and leaked more often and required more nursing time. CONCLUSIONS: Both patients and nursing staff prefer condom to indwelling catheters for patient comfort, but they recognize that dislodgment and leaking are major drawbacks of condom catheters. A more secure condom catheter would greatly improve the management of male incontinence.     

Confronting and eradicating an epidemic of bacteraemia

Obtaining vascular access by catheterisation is a good option, especially in patients with vascular system fragility. In the authors' department, there was an increase in Gram Negative Bacillus (GNB) infection in patients with long term catheters (LTC). An objective was set to design an action plan and a new working methodology in order to eradicate the infection and the cause. Three periods were established in the prospective follow-up of LTC patients: the pre-epidemic period (01/94 to 03/99), with a bacteraemia every 144 days per patient, the epidemic period (04/99 to 12/00) with a bacteraemia every ten days per patient, and the post-epidemic period (01/01 to 04/02). A multidisciplinary working group was established, which produced action plans for nursing and technical staff. The working methodology of the service was studied and analysed by means of a review. The deionised water cultures at the entrance to the haemodialysis ward were negative. The dialysis and connector cultures were positive for GNB, confirming that they were of the same genetic origin. An evaluation of the periods was carried out, studying the working methodology, to which no changes were made between the pre-epidemic and epidemic period. In the post-epidemic period, a number of changes were made to the care dynamic, with no other bacteraemia arising to date. Adapting and improving protocols is a good indicator of quality. The role of nursing staff is vital in prevention of GNB.     

Value of multiplex PCR using cerebrospinal fluid for the diagnosis of ventriculostomy-related meningitis in neurosurgery patients

Purpose

This prospective observational cohort study assessed the use of a multiplex real-time polymerase chain reaction (PCR) assay alone and in conjunction with biomarkers for the diagnosis of ventriculostomy-related meningitis in neurosurgery intensive care unit (ICU) patients with external ventricular drainage (EVD).

Methods

Concentrations of intrathecal biomarkers, including lactate and interleukin 6 (IL-6), were measured, and cerebrospinal fluid (CSF) was examined microbiologically by blood culture BACTEC bottles in 62 CSF samples from 41 patients with EVD. A portion of each sample was also tested with a commercially available PCR assay that simultaneously detects 25 species of bacteria and fungi [SeptiFast (SF)]. Receiver operating characteristic curve analysis was used to compare biomarker concentrations with SF and culture results.

Results

Seventeen (27 %) samples tested positive and 40 (65 %) tested negative for pathogens by both culture and SF. One pathogen was detected only by SF. Four samples tested positive by culture but negative by SF; in 3 of these, the isolates were considered to be contaminants. In comparison to CSF culture SF showed a larger area under the curve for IL-6 (0.90; 95 % CI 0.83–0.98) versus 0.70 (95 % CI 0.46–0.80) and for lactate (0.77; 95 % CI 0.63–0.93) versus 0.65 (95 % CI 0.50–0.80). In 94 % (17/18) of positive SF samples the results were obtained on the same day whereas the overall mean of the time-to-positivity of BACTEC bottles was 21.6 h.

Conclusions

The diagnosis of EVD-related ventriculo-meningitis in neurosurgical ICU patients can be established in a rapid manner using a multiplex PCR assay on CSF samples in combination with intrathecal biomarkers.     

Involvement of central nervous system in adult patients with acute myeloid leukemia: Incidence and impact on outcome

Incidence and effect on outcome of central nervous system (CNS) involvement in adult patients with acute myeloid leukemia (AML) is not clearly defined. To address this issue, 103 consecutive adult patients with newly diagnosed AML, regardless of neurologic symptoms, were submitted to a routine explorative lumbar puncture. Cerebrospinal fluid (CSF) samples were collected from 65 males and 38 females. All 103 CSF samples were examined by conventional cytology (CC) whereas 95 (92%) also by flow cytometry (FCM). At diagnosis, 70 patients (68%) were CNS negative (CNS−), whereas 33 (32%) were CNS positive (CNS+). In 11 of 33 (33%), CNS infiltration was documented either by CC or FCM , in 21 (67%) only by FCM. CNS positivity was significantly associated with a M4-M5 phenotype of the underlying AML (P = .0003) and with high levels of lactate dehydrogenase (P = .006). Overall, 80 of 103 (78%) achieved complete remission with no significant differences between CNS+ and CNS− patients. Five-year disease-free survival and overall survival were found to be shorter in CNS+ patients than in those CNS− (18% vs 50%, P = .006 and 19% vs 46%, P = .02, respectively). In multivariate analysis, CNS status and age were found to affect independently overall survival. In conclusion, the incidence of CNS involvement in adult patients with newly diagnosed AML is higher than expected. Regardless of neurologic symptoms, it should always be searched at diagnosis; CSF samples should routinely be investigated by FCM since a certain proportion of CNS involvements might remain undetected if examination is exclusively CC based.     

Candida auris: descripción de un brote

Candida auris is an emerging multidrug-resistant yeast that causes serious invasive infections and outbreaks with high mortality. Controlling C. auris is a challenge in which laboratories, clinicians and public health agencies are needed to identify and treat infections and prevent transmission. This review describes the general aspects of the biology, diagnosis and treatment of C. auris infection, as well as the main recommendations recently published by expert groups. We also present our experience of the C. auris outbreak at the Consorcio Hospital General Universitario de Valencia from September 2017 to August 2019. A total of 203 patients were colonised and/or infected by C. auris. Thirty invasive infections (29 blood cultures and one case of meningitis) were diagnosed. In all, 32% cases of candidemia were caused by C. auris in 2018. All strains were resistant to fluconazole.     

An outbreak of nosocomial hepatitis B virus infection in a nursing home for the elderly in Antwerp (Belgium)

After notification of a case of fulminant hepatitis B virus (HBV) infection in a 83-year-old female resident of a nursing home to the Flemish Health Inspectorate, a seroepidemiological study and a retrospective cohort study were conducted among the 94 residents and 47 nursing staff to assess the extent of HBV transmission and to identify risk factors. Susceptible residents were vaccinated against HBV and their serological response to hepatitis B vaccination determined. From December 2002 to April 2003, five residents with acute hepatitis B infection were identified with an attack rate of 5.5% and a case fatality rate of 40%. Three other residents were identified as HBV surface antigen and e-antigen positive carrier. None of the nursing staff tested positive for acute HBV infection or HBV carriage. Diabetic patients who were exposed to a shared finger-stick device for blood sampling were 10.7 times more likely to contract an acute HBV infection (RR 10.7; 95% CI 1.3-91.3). Other potential risk factors were undergoing podiatric care and being exposed to the shared razor blade of the hairdresser. The transmission of the infection could be controlled by restricting the use of finger-stick capillary sampling devices to individual patients, assigning separate glucometers to individual patients and, implementation of standard infection-control recommendations like wearing gloves and performing hand hygiene by the nursing staff, assigning separate podiatric sets to individual patients. HBV vaccination of the residents with three doses of HBV vaccine has not induced a sufficient degree of protection. The outbreak stresses the need for appropriate and generally applied standard procedures in nursing homes to prevent bloodborne pathogens.     

Improved outcome in central nervous system aspergillosis, using voriconazole treatment

The mortality of central nervous system (CNS) aspergillosis approaches 100%, requiring improved therapies. Voriconazole gives superior efficacy and survival in invasive aspergillosis, compared with amphotericin B. Also, in contrast to other antifungal drugs, voriconazole penetrates well into the CNS. We evaluated, retrospectively, the outcome and survival of 81 patients who were treated with voriconazole for definite (n = 48) or probable (n = 33) CNS aspergillosis. Complete and partial responses were recorded in 35% of patients and varied by the underlying disease group: hematologic malignancies (54%), other underlying conditions (50%), chronic immunosuppression (45%), solid organ transplantation (36%), and hematopoietic stem cell transplantation (16%). Thirty-one percent of patients survived CNS aspergillosis for a median observation time of 390 days. There were 31 patients who underwent neurosurgical procedures, including craniotomy/abscess resection (n = 14), abscess drainage (n = 12), ventricular shunt (n = 4), and Ommaya-reservoir (n = 1). Multifactorial analysis revealed that neurosurgery was associated with improved survival (P = .02). Patients who underwent hematopoietic stem cell transplantation had a poorer survival (P = .02), but 7 (22%) of 32 survived for a median of 203 days. We conclude from this large cohort of patients that voriconazole treatment together with neurosurgical management, whenever feasible, is currently the best approach to treat patients with CNS aspergillosis.     

神经外科重症监护医学助推神经外科发展得更快、更高、更强

神经外科重症监护在神经外科危重疾病的治疗中起至关重要的作用。由于中国神经外科重症监护的学科建设滞后于西方发达国家,并且受各地区经济发展、神经外科科室规模、技术水平差异较大等因素的制约,故仍处于起步阶段。作者借鉴国外神经外科重症的发展历史,回顾中国神经外科重症监护二十多年的发展历史过程,期待对神经外科重症监护的科室建设、理念的形成以及专业队伍的扩大等方面,起到积极的促进作用,并助推神经外科向更高、更难、更强的领域进步与发展。