Current Practices of Intraventricular Antibiotic Therapy in the Treatment of Meningitis and Ventriculitis: Results from a Multicenter Retrospective Cohort Study

Lewin, John J.; Cook, Aaron M.; Gonzales, Cynthia; Merola, David; Neyens, Ron; Peppard, William; Brophy, Gretchen M.; Kurczewski, Lisa; Giarratano, Melissa; Makii, Jason; Rowe, A. Shaun; Tesoro, Eljim P.; Zaniewski, Amber; Clark, Sarah L.; Ziai, Wendy

doi:10.1007/s12028-018-0647-0

Cited by 40 publications

(46 citation statements)

References 24 publications

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“…Therapeutic drug monitoring of the trough levels immediately before the next intraventricular dose in conjunction with quantitative assessment of the MIC of the pathogen responsible by microdilution or Etest provides valuable data on the relationship between the trough concentration and MIC but at present is not mandatory. In a recent retrospective multicenter study in 105 patients, antimicrobial CSF concentrations were measured in 63% of surviving and 37% of nonsurviving patients (P ϭ 0.02) (42). We are not aware of any other study demonstrating that therapeutic drug monitoring after intraventricular dosing improved outcomes.…”

Section: Therapeutic Drug Monitoringmentioning

confidence: 94%

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Intrathecal Antibacterial and Antifungal Therapies

2020

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SUMMARY Intrathecal administration of anti-infectives is indicated in central nervous system infections by multiresistant pathogens when drugs that can reach adequate cerebrospinal fluid (CSF) concentrations by systemic therapy are not available. Antibiotics that readily pass the blood-brain and blood-CSF barriers and/or that have low toxicity allowing an increase in the daily dosage should not be used for intrathecal therapy. Intrathecal therapy is accompanied by systemic treatment. Antibacterials indispensable for intrathecal therapy include aminoglycosides, colistin, daptomycin, tigecycline, and vancomycin. Limited experience suggests the utility of the antifungals amphotericin B and caspofungin. Intraventricular administration ensures distribution throughout the CSF compartment, whereas intralumbar dosing often fails to attain adequate antibiotic concentrations in the ventricles. The individual dose is determined by the estimated size of the CSF space and by the estimated clearance from CSF. For moderately lipophilic anti-infectives with a molecular weight above approximately 1,000 g/mol, as well as for hydrophilic drugs with a molecular weight above approximately 400 g/mol, one daily dose is normally adequate. The ventricular drain should be clamped for 15 to 120 min to facilitate the distribution of the anti-infective in the CSF space. Therapeutic drug monitoring of the trough levels is necessary only in cases of therapeutic failure.

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Section: Therapeutic Drug Monitoringmentioning

confidence: 94%

“…In 9.5% of the patients, either the infection relapsed or the CSF cultures remained positive. The overall in-hospital mortality rate was 18.1% (42).…”

Section: Case Reports and Case Seriesmentioning

confidence: 95%

Intrathecal Antibacterial and Antifungal Therapies

2020

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“…Since the time we treated our patient, a recent multicenter retrospective cohort study on intraventricular antibiotic therapy for meningitis and ventriculitis by Lewin et al suggested that daily use of gentamicin or tobramycin with a mean dose of 6.7 mg for a median duration of 6 days (a shorter course than our regiment) resulted in sterilisation of CSF cultures in 93.4% of subjects 14. The author also highlighted recent guidelines published in 2017 by the Infectious Disease Society of America (IDSA) for the use of intraventricular antibiotic therapy in healthcare-acquired ventriculitis and meningitis 15. One of the essential points by the Lewin et al is an emphasis to consider guiding intraventricular aminoglycoside therapy by CSF drug level concentrations to avoid ototoxicity, consistent with the guidelines proposed by the IDSA.…”

Section: Discussionmentioning

confidence: 69%

Use of ventriculostomy in the treatment of septic cavernous sinus thrombosis (SCST)

Thomas¹,

Fayad

Tong

et al. 2019

BMJ Case Rep

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We present a novel treatment with the use of intraventricular antibiotics delivered through a ventriculostomy in a patient who developed septic cavernous sinus thrombosis after sinus surgery. A 65-year-old woman presented with acute on chronic sinusitis. The patient underwent a diagnostic left maxillary antrostomy, ethmoidectomy, sphenoidotomy and sinusotomy. Postoperatively, the patient experienced altered mental status with episodic fever despite treatment with broad-spectrum antimicrobial therapy. MRI of the brain showed extensive meningeal enhancement with the involvement of the right trigeminal and abducens nerve along with thick enhancement along the right pons and midbrain. MR arteriogram revealed a large filling defect within the cavernous sinus. Intraventricular gentamicin was administered via external ventricular drain (ie, ventriculostomy) every 24 hours for 14 days with continued treatment of intravenous ceftriaxone and metronidazole. The patient improved with complete resolution of her cavernous sinus meningitis on repeat brain imaging at 6 months posthospitalisation.

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“…Common pathogens include Klebsiella species, Pseudomonas species, Acinetobacter baumannii, and Escherichia coli. 33,34 Third-and fourth-generation cephalosporins are common first-line empiric agents, though carbapenems can be considered as well. 13 Resistant organisms may require the use of aminoglycosides, polymyxin B, or colistin via intravenous or intrathecal route.…”

Section: Gram-negative Bacillimentioning

confidence: 99%

Pharmacologic Treatment of Meningitis and Encephalitis in Adult Patients

Treister

Koerner

2019

Journal of Neuroanaesthesiology and Critical Care

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Meningitis and encephalitis are two inflammatory, often infectious, disorders of the meninges and the central nervous system. Both are associated with significant morbidity and mortality, and require early and aggressive targeted treatment. This article reviews pharmacologic treatment strategies for infectious meningitis and encephalitis, using the latest available research and guidelines. It provides an overview of empiric antimicrobial treatment approaches for a variety of organisms, including a discussion of trends in antibiotic resistance where applicable. Key steps in diagnosis and general management are briefly reviewed.

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Current Practices of Intraventricular Antibiotic Therapy in the Treatment of Meningitis and Ventriculitis: Results from a Multicenter Retrospective Cohort Study

Cited by 40 publications

References 24 publications

Intrathecal Antibacterial and Antifungal Therapies

Intrathecal Antibacterial and Antifungal Therapies

Use of ventriculostomy in the treatment of septic cavernous sinus thrombosis (SCST)

Pharmacologic Treatment of Meningitis and Encephalitis in Adult Patients

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