Healthcare-associated ventriculitis: current and emerging diagnostic and treatment strategies

Hasbun, Rodrigo

doi:10.1080/14787210.2021.1866544

Cited by 19 publications

(17 citation statements)

References 57 publications

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“…Ventriculitis can result secondary to severe meningitis affecting the basal cisterns, after rupture of a brain abscess into the ventricles, associated with a CNS device such as a ventriculoperitoneal shunt or an external ventricular drain [23], or with cytomegalovirus [24]. Imaging shows thickening and enhancement of the ependyma.…”

Section: Ventriculitismentioning

confidence: 99%

Neuroradiology of infectious diseases

Singh

Hasbun

2021

Current Opinion in Infectious Diseases

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Purpose of review Early diagnosis of central nervous system (CNS) infections is crucial given high morbidity and mortality. Neuroimaging in CNS infections is widely used to aid in the diagnosis, treatment and to assess the response to antibiotic and neurosurgical interventions. Recent findings The Infectious Diseases Society of America (IDSA) guidelines have clear recommendations for obtaining a computerized tomography of the head (CTH) prior to lumbar puncture (LP) in suspected meningitis. In the absence of indications for imaging or in aseptic meningitis, cranial imaging is of low utility. In contrast, cranial imaging is of utmost importance in the setting of encephalitis, bacterial meningitis, ventriculitis, bacterial brain abscess, subdural empyema, epidural abscess, neurobrucellosis, neurocysticercosis, and CNS tuberculosis that can aid clinicians with the differential diagnosis, source of infection (e.g., otitis, sinusitis), assessing complications of meningitis (e.g., hydrocephalus, venous sinus thrombosis, strokes), need for neurosurgical interventions and to monitor for the response of therapy. Novel imaging techniques such as fast imaging employing steady-state acquisition (FIESTA), susceptibility-weighted imaging (SWI), and chemical exchange saturation transfer (CEST) contrast are briefly discussed. Summary Though the radiological findings in CNS infections are vast, certain patterns along with clinical clues from history and examination often pave the way to early diagnosis. This review reiterates the importance of obtaining cranial imaging when necessary, and the various radiological presentations of commonly encountered CNS infections.

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Section: Ventriculitismentioning

confidence: 99%

Neuroradiology of infectious diseases

Singh

Hasbun

2021

Current Opinion in Infectious Diseases

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“…Vancomycin is commonly used in postoperative neurosurgical patients for empirical anti-infective treatment due to the low success rate of bacterial culture in cerebrospinal fluid (about 20%) and the high mortality of intracranial infection ( Tunkel et al, 2017 ; Hasbun, 2021 ; Schneider et al, 2022 ). Postoperative neurosurgical patients usually experience significant pathophysiological changes, including the destruction of the blood-brain barrier or blood-cerebrospinal fluid barrier, the increase of heart output, and augmented renal function ( Blot et al, 2014 ; Xiao et al, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

Population pharmacokinetic model of vancomycin in postoperative neurosurgical patients

et al. 2022

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Objective: Vancomycin is commonly used in postoperative neurosurgical patients for empirical anti-infective treatment due to the low success rate of bacterial culture in cerebrospinal fluid (about 20%) and the high mortality of intracranial infection. At conventional doses, the rate of target achievement for vancomycin trough concentration is low and the pharmacokinetics of vancomycin varies greatly in these patients, which often leads to treatment failure. The objective of this study was to establish a population pharmacokinetic (PPK) model of vancomycin in postoperative neurosurgical patients for precision medicine.Method: A total of 895 vancomycin plasma concentrations from 560 patients (497 postoperative neurosurgical patients) were retrospectively collected. The model was analyzed by nonlinear mixed effects modeling method. One-compartment model and mixed residual model was employed. The influence of covariates on model parameters was tested by forward addition and backward elimination. Goodness-of-fit, bootstrap and visual predictive check were used for model evaluation. Monte Carlo simulations were employed for dosing strategies with AUC24 targets 400–600.Result: Estimated glomerular filtration rate (eGFR), body weight (BW) and mannitol had significant influence on vancomycin clearance (CL). eGFR(mL/min)=144×(Scr/a)b×0.993age, for female, a = 0.7, Scr ≤ 0.7 mg/dl, b = −0.329, Scr > 0.7 mg/dl, b = −1.209; for male, a = 0.9, Scr ≤ 0.9 mg/dl, b = −0.411, Scr > 0.9 mg/dl, b = −1.210. Vancomycin clearance was accelerated when co-medicated with mannitol and increased with eGFR and BW. In the final model, the population typical value is 7.98 L/h for CL and 60.2 L for apparent distribution volume, CL (L/h)=7.98×(eGFR/115.2)0.8×(BW/70)0.3×eA, where A = 0.13 when co-medicated with mannitol, otherwise A = 0. The model is stable and effective, with good predictability.Conclusion: In postoperative neurosurgical patients, a higher dose of vancomycin may be required due to the augmented renal function and the commonly used mannitol, especially in those with high body weight. Our vancomycin PPK model could be used for individualized treatment in postoperative neurosurgical patients.

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“…Ventriculitis is a severe central nervous system (CNS) condition that involves inflammation of the ependymal lining of the cerebral ventricles [ 1 ]. Common symptoms include fever, altered mental status, severe headaches, and sepsis [ 2 ].…”

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confidence: 99%

“…A wide range of pathogens have been implicated, but with nosocomial ventriculitis, many indolent pathogens are implicated, thus not allowing for these pathogens to be readily cultured [ 2 ]. Treatment entails rapid identification and aggressive antimicrobial treatment to prevent long-term sequalae and reduce mortality [ 1 , 2 ].…”

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confidence: 99%

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Use of α-Defensins to Help Diagnose Nosocomial Ventriculitis

Doub

2022

Neurocrit Care

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Ventriculitis is a severe complication of indwelling neurosurgical devices that is associated with significant morbidity and mortality. The incidence rate of ventriculitis is approximately 10% with external ventricular drains. Obstinately, patients with these indwelling neurosurgical devices are prone to have traditional cerebral spinal fluid parameters that lack sensitivity and specificity in diagnosing nosocomial ventriculitis. In addition, diagnosis can be arduous given that indolent pathogens are commonly implicated. Therefore, diagnosis is difficult but paramount to thwart the morbidity and mortality associated with this infectious condition as well as to reduce the prolonged use of broad-spectrum antibiotics. As we extrapolate from prosthetic joint infections, for which diagnosis can also be challenging, we learn that the use of α-defensins as a diagnostic biomarker for nosocomial ventriculitis may hold promise. Herein, the viewpoint of using α-defensins as a diagnostic biomarker for nosocomial ventriculitis is discussed.

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Healthcare-associated ventriculitis: current and emerging diagnostic and treatment strategies

Cited by 19 publications

References 57 publications

Neuroradiology of infectious diseases

Neuroradiology of infectious diseases

Population pharmacokinetic model of vancomycin in postoperative neurosurgical patients

Use of α-Defensins to Help Diagnose Nosocomial Ventriculitis

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