Diagnosis and treatment of severe neurosurgical patients with pyogenic ventriculitis caused by gram-negative bacteria

Abstract

The aim of the study is to explore the experiences in diagnosis and treatment of severe neurosurgical patients with pyogenic ventriculitis caused by gram-negative bacteria (G). Nineteen patients with pyogenic ventriculitis were reviewed for their treatment. The bacterial testing results of cerebrospinal fluid (CSF), the clinical intervention, and the patients' prognosis were evaluated. The bacterial smears of ventricular drainage from all the cases were G bacteria. Head CT and MRI scans confirmed that they were intraventricular empyema. Eighteen cases of CSF bacterial test were positive, including 12 cases of Acinetobacter baumannii positive, 2 of Klebsiella pneumonia positive, 2 of Serratia marcescens positive, 1 of Pseudomonas maltophila positive, and 1 case of Escherichia coli positive. One case of the bacterial culture was negative. All patients were treated by using intraventricular lavage in combination with intravenous and intraventricular antibiotics in accordance with the clinical conditions. After treatment for 2 to 8 weeks, 14 patients were cured (74%) and 5 were died (26%). Eight patients who were cured had received ventriculoperitoneal shunt due to hydrocephalus at 2 to 6 weeks after infection controlled, and none of them had any reinfection. Twelve of the 14 cured cases came to consciousness, but 2 were persistent in vegetative state starting before the infection; they did not show any improving consciousness after infection had been cured. Suppurative ventriculitis in severe neurosurgical patients is mainly infected by G with a higher mortality. Early diagnosis, especially in identifying pathogen types, timely ventricular irrigation, and ventricular drainage together with intravenous and intraventricular antibiotic treatment, should improve prognosis.

<p>A Clinical Study on the Use of Intraventricular Polymyxin B Supplemented by Continuous External Ventricular Drainage in the Treatment of Drug-Resistant Gram-Negative Bacilli Intracranial Infection</p>

“…According to reports, the mortality rate associated with intracranial infections caused by MDR/XDR G-bacilli is as high as 26-71%. [22][23][24] The total mortality rate in this study was 17.6% (5/28), and the mortality rate directly caused by infection was 7.1% (2/28), which was lower than that reported in the literature. This may be related to the timely use of intraventricular polymyxin B following the identification of MDR/XDR G-bacilli in the patients in this study.…”

“…Recently, Shang et al reported that intraventricular lavage combined with daily polymyxin E can effectively improve the neurological symptoms and CSF laboratory indicators in patients with severe ventricular inflammation. 22 In this study, intraventricular polymyxin B has also been used to achieve the same effect.…”

“…Studies have shown that artificial materials related to infections should be completely removed as soon as possible during intracranial infections. 6,18 In addition, smooth and continuous CSF drainage is essential for the treatment of severe intracranial infection, 22 usually using external ventricular drainage or lumbar cistern drainage. Most researchers believe that lumbar cistern drainage is more effective at reducing the recurrence of intracranial infections.…”

Risk Factors for Hydrocephalus in Neonatal Purulent Meningitis: A Single-Center Retrospective Analysis

“…6 Studies have found that timely intervention in hydrocephalus can help patients to achieve better prognosis because hydrocephalus secondary to purulent infection contains viscous pus that affect the concentration of antibiotics in the ventricular system and thus affecting the treatment outcome. 7,8 Therefore, it is of great importance to determine the predicting factors of hydrocephalus in meningitis patients. To provide insights for early diagnosis and treatment of hydrocephalus, we conducted a single-center retrospective study to evaluate the risk factors for hydrocephalus in neonatal purulent meningitis and discuss the characteristics of the disease.…”

A report on pneumonia-induced ventriculitis with intraventricular abscess

“…[ 2 ] Clinically, most patients with ventriculitis present with fever, deterioration of the conscious level, and dysneuria. [ 3 ] Delayed in the diagnosis and treatment will lead to severe intracranial infection, serious neurological impairment, and death. Most cases of ventriculitis have been reported in the newborns and infants, with bacteria being the most common pathogens, although several cases of ventriculitis secondary to aspergillus fumigatus infection have been described.…”