Intraventricular and lumbar intrathecal administration of antibiotics in postneurosurgical patients with meningitis and/or ventriculitis in a serious clinical state

Abstract

Object. To date, reports on the clinical efficacy of intraventricularly and intrathecally administered antibiotics for the treatment of neurosurgical ventriculitis and meningitis in adults are limited. The authors aimed to evaluate the efficacy and safety of the intraventricular (IVT) and lumbar intrathecal (IT) administration of antibiotics in critically ill neurosurgical patients.Methods. Thirty-four postneurosurgical patients with meningitis and ventriculitis were studied. Intraventricular/ lumbar intrathecal antibiotics were administered due to positive CSF cultures persisting despite the use of intravenous antibiotics. The time period until CSF sterilization, changes in clinical state, and efficacy of different routes of antibiotic administration were evaluated.Results. The mean time necessary to obtain CSF sterilization was 2.9 ± 2.7 days (range 1-12 days). The CSF cultures became negative within 24 hours after the administration of IVT/IT antibiotics in 17 patients (50%) and up to 48 hours in a further 6 patients (18%). The clinical outcome of patients assessed by the modified Rankin Scale improved in 17 patients (50%), stayed unchanged in 10 patients (29%), and was impaired in 1 patient (3%). Six patients (18%) died; however, 2 of them died due to reasons not directly related to meningitis or ventriculitis, so the overall mortality rate for meningitis and/or ventriculitis was 11.8% in this group of patients. All patients with ventriculitis (n = 4) were treated by antibiotics administered via the IVT route. The average time to CSF sterilization was 6.5 days in the patients with ventriculitis. Thirty patients had clinical signs of meningitis without ventriculitis. Despite the higher ratio of unfavorable Gram-negative meningitis in the subgroup of patients treated via lumbar drainage, the mean duration of CSF sterilization was 2.2 days compared with 2.6 days in the subgroup treated via external ventricular drainage, a difference that was not statistically significant (p = 0.3). Adverse effects of IVT/IT antibiotics appeared in 3 of 34 patients and were of low clinical significance.Conclusions. Intraventricular/lumbar intrathecal antibiotics can lead to very quick CSF sterilization in postneurosurgical patients with meningitis and ventriculitis. The relapse rate of meningitis and/or ventriculitis is also very low among patients treated by IVT/IT antibiotics. Intraventricular/lumbar intrathecal administration of antibiotics appears to be an effective and safe treatment for infections of the CNS caused by multidrug-resistant organisms. In patients with signs of ventriculitis, the authors prefer the IVT route of antibiotics. This study did not prove a lower efficacy of administration of antibiotics via lumbar drainage compared with the ventricular route in patients with meningitis. (http://thejns.org/doi/abs/10.3171/2013.6.JNS122126) key WorDs • antibiotic • intraventricular • intrathecal • meningitis • ventriculitis • brain abscess • infectionAbbreviations used in this paper: EVD = external ventricular dra...

International Consensus Guidelines for the Optimal Use of the Polymyxins: Endorsed by the American College of Clinical Pharmacy (ACCP), European Society of Clinical Microbiology and Infectious Diseases (ESCMID), Infectious Diseases Society of America (IDSA), International Society for Anti‐infective Pharmacology (ISAP), Society of Critical Care Medicine (SCCM), and Society of Infectious Diseases Pharmacists (SIDP)

“…A systematic review of the evidence regarding clinical efficacy and safety of IVT or ITH colistin or polymyxin B was conducted . A total of 234 cases of gram‐negative health care–associated ventriculitis or meningitis treated with IVT or ITH colistin or polymyxin B were reported.…”

“…153 A systematic review of the evidence regarding clinical efficacy and safety of IVT or ITH colistin or polymyxin B was conducted. [159][160][161][162][163][164][165][166][167][168][169][170][171][172][173][174][175][176] A total of 234 cases of gram-negative health care-associated ventriculitis or meningitis treated with IVT or ITH colistin or polymyxin B were reported. Intraventricular or ITH colistin was administered in 87% of cases and polymyxin B in the remaining 13%.…”

Will clinical parameters reliably predict external ventricular drain-associated ventriculitis: Is frequent routine cerebrospinal fluid surveillance necessary?

“…[11] The overall mortality rate among patients with ventriculitis has been reported to be in the 8–70% range, with the highest rates reported before the introduction of third-generation cephalosporins. [9]…”

Review of the international consensus guidelines for the optimal use of the polymyxins

“…Был проведен систематический обзор доказательных данных в отношении клинической эффективности и безопасности ИВТ или ИТК введения колистина [159][160][161][162][163][164][165][166][167][168][169][170][171][172][173][174][175][176]. В общей сложности было включено 234 случая нозокомиального грамотрицательного вентрикулита или менингита, в отношении которых применялось ИВТ или ИТК введение колистина или полимиксина В. Интравентрикулярный или ИТК колистин применялся в 87% случаев, в то время как полимиксин В -в оставшихся 13%.…”