Intraventricular antimicrobial therapy in postneurosurgical Gram-negative bacillary meningitis or ventriculitis: A hospital-based retrospective study

Wang, Jui-Hsing; Lin, Pin Wen; Chou, Chia-Hui; Ho, Cheng-Mao; Lin, Kuo-Hsi; Tsai, Chia-Ta; Wang, Jen-Hsien; Chi, Chih-Yu; Ho, Mao‐Wang

doi:10.1016/j.jmii.2012.08.028

Cited by 69 publications

(57 citation statements)

References 21 publications

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“…Penicillins and cephalosporins should not be given by the intrathecal route because they have been associated with significant neurotoxicity, especially seizures [116]. In several studies on the pharmacokinetics, safety, and efficacy of intraventricular administration of antimicrobial agents [119,[122][123][124][125][126], CSF sterility and normalization of CSF parameters were achieved sooner with intraventricular and intravenous use when compared to intravenous use alone, especially in adults. Combined intravenous and intraventricular use of vancomycin may improve CSF vancomycin concentrations without side effects [127].…”

Section: Evidence Summarymentioning

confidence: 99%

“…It is challenging to determine the correct dosing regimen because the CSF concentrations obtained for the same intraventricular dose in pharmacokinetic studies have been highly variable, probably due to the differences among patients in the volume of distribution, ventricular size, or variable CSF clearance as a result of CSF drainage [119,[122][123][124][125][126][127][128][129]. In a consensus guideline, the British Society for Antimicrobial Chemotherapy Working Party on Infections in Neurosurgery recommended that the initial dose of an intraventricular antimicrobial be based on ventricular volume as estimated by neuroimaging [118].…”

Section: Evidence Summarymentioning

confidence: 99%

“…Although there are methodological limitations in published studies, intraventricular vancomycin was shown to be safe and efficacious in a systematic review in adults [124]. Intraventricular aminoglycosides were also shown to be effective [122,126]. In one study, there were no relapses when intraventricular gentamicin was combined with intravenous meropenem in patients with neurosurgical gram-negative bacillary ventriculitis and meningitis [126].…”

Section: Evidence Summarymentioning

confidence: 99%

See 2 more Smart Citations

2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis*

Tunkel

Hasbun

Bhimraj

et al. 2017

Clinical Infectious Diseases

659

671

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The Infectious Diseases Society of America (IDSA) Standards and Practice Guidelines Committee collaborated with partner organizations to convene a panel of 10 experts on healthcare-associated ventriculitis and meningitis. The panel represented pediatric and adult specialists in the field of infectious diseases and represented other organizations whose members care for patients with healthcare-associated ventriculitis and meningitis (American Academy of Neurology, American Association of Neurological Surgeons, and Neurocritical Care Society). The panel reviewed articles based on literature reviews, review articles and book chapters, evaluated the evidence and drafted recommendations. Questions were reviewed and approved by panel members. Subcategories were included for some questions based on specific populations of patients who may develop healthcare-associated ventriculitis and meningitis after the following procedures or situations: cerebrospinal fluid shunts, cerebrospinal fluid drains, implantation of intrathecal infusion pumps, implantation of deep brain stimulation hardware, and general neurosurgery and head trauma. Recommendations were followed by the strength of the recommendation and the quality of the evidence supporting the recommendation. Many recommendations, however, were based on expert opinion because rigorous clinical data are not available. These guidelines represent a practical and useful approach to assist practicing clinicians in the management of these challenging infections.

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Section: Evidence Summarymentioning

confidence: 99%

Section: Evidence Summarymentioning

confidence: 99%

Section: Evidence Summarymentioning

confidence: 99%

See 1 more Smart Citation

2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis*

Tunkel

Hasbun

Bhimraj

et al. 2017

Clinical Infectious Diseases

659

671

View full text Add to dashboard Cite

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“…In the Grenoble cohort, amikacin was administered via the intraventricular route prior to EVD removal to prevent gram-negative bacillary ventriculitis, which would be devastating in these patients. 29 According to a recent systematic review, the administration of aminoglycosides via this route appeared safe and effective for the treatment of EVD-related infections. 16 Although the prophylactic effectiveness of such action needs to be confirmed, all 3 cases of ventriculitis in the Grenoble cohort presented after EVD removal (see Appendix 2).…”

Section: Discussionmentioning

confidence: 99%

Strategies to reduce external ventricular drain–related infections: a multicenter retrospective study

Champey

Mourey

Francony

et al. 2019

Journal of Neurosurgery

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OBJECTIVE Various strategies have been proposed to reduce the incidence of external ventricular drain (EVD)-related infections. The authors retrospectively studied the impact of EVD care management on EVD-related infections at 3 French university hospital intensive care units. METHODS Between 2010 and 2014, 462 consecutive adult patients with no evidence of a preexisting CSF infection received EVDs as part of their care at one of the following sites: Grenoble (221 patients), Saint-Etienne (130 patients), and Marseille (111 patients). Written protocols describing the EVD placement procedure, management, and removal were implemented at the 3 sites. Daily CSF sampling and intraventricular administration of antibiotics prior to EVD removal were performed at the Grenoble site only. EVD-related infection was considered for any confirmed ventriculostomy-related infection (VRI) and ventriculitis. VRI was defined as one or more positive CSF cultures or Gram stain with CSF pleocytosis and biochemical abnormalities. Ventriculitis was defined as CSF pleocytosis and biochemical abnormalities with degradation of neurological status and fever. RESULTS A total of 6945 EVD days were observed in the entire population. In the Grenoble cohort, the mean cumulative incidence of EVD-related infections was significantly lower than that in the 2 other cohorts: 1.4% (95% CI 0.0%-2.9%) versus 9.2% (95% CI 4.2%-14.2%) and 7.2% (95% CI 2.4%-12.0%) at Saint-Etienne and Marseille, respectively (p < 0.01). Accounting for the duration of external ventricular drainage at each site, the risk for EVD-related CSF infections was significantly higher at Saint-Etienne and Marseille than at Grenoble, with ORs of 15.9 (95% CI 3.6-71.4, p < 0.001) and 10.0 (95% CI 2.2-45.5, p = 0.003), respectively. CONCLUSIONS These findings indicate that it is possible to attain a low incidence of EVD-related infections, provided that an EVD care bundle, which can include routine daily CSF sampling, is implemented and strongly adhered to.

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“…The antibiotics that have been reported include linezolid, meropenem and metronidazole. The use of a sequential combination of intravenous antibiotics and intraventricular antimicrobial therapy (IVT) therapy has also been reported [32].…”

Section: Discussionmentioning

confidence: 99%

Ventriculo-peritoneal shunt trans-anal protrusion causing Escherichia coli ventriculitis in child: Case report and review of the literature

Liu

Tian

2017

Chin Neurosurg Jl

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Background: Ventriculo-peritoneal shunting is an effective treatment for hydrocephalus, bowel perforation by peritoneal catheters is an extremely rare complications associated with this procedure. Case presentation: We report a 9-year-old girl who had anal VP shunt protrusion two months following surgery and review the literature to understand the diagnosis and treatment for this rare complication. A PubMed search using the keywords 'bowel perforation' and 'Escherichia coli ventriculitis' was performed and citations were reviewed. Conclusions: Neurosurgeons should be alert to early diagnosis and appropriate treatment of this condition to prevent infectious and neurological complications.

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Intraventricular antimicrobial therapy in postneurosurgical Gram-negative bacillary meningitis or ventriculitis: A hospital-based retrospective study

Abstract: The findings of this study suggest that IVT antibiotic therapy is a useful option in the treatment of postneurosurgical GNBM or ventriculitis, especially for those with a treatment-refractory state.

Cited by 69 publications

References 21 publications

2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis*

2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis*

Strategies to reduce external ventricular drain–related infections: a multicenter retrospective study

Ventriculo-peritoneal shunt trans-anal protrusion causing Escherichia coli ventriculitis in child: Case report and review of the literature

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