Successful Treatment of Pseudomonas Aeruginosa—Ventriculitis with Intraventricular Gentamicin in a Child with Hydrocephalus

Abstract

A hydrocephalic child, who was operated with a ventriculo-peritoneal shunt at the age of 1 month, developed ventriculitis due to Pseudomonas aeruginosa at 8 months. After removal of the shunt and successively increasing intramuscular and intraventricular doses of gentamicin the patient was cured and a new shunt could be inserted. As high 24-hour gentamicin level in the cerebrospinal fluid as 76 microgram/ml was reached without any apparent toxic signs.

Intraventricular Tobramycin in a Premature Infant with Pseudomonas Meningitis

“…Olsen and colleagues advocated the need for 24-hour post-dose CSF concentrations of at least 25-35 µg/mL for P aeruginosa ventriculitis. 6 The use of high trough concentrations in the CSF was also supported by Lorber et al 10 This group reported a correlation between successful treatment and a trough (i.e., 24-hour post-IVT dose) gentamicin CSF concentration that 'exceeded manyfold the MIC' of the organism. Pickering and colleagues targeted a goal CSF trough gentamicin concentration that was four times the minimal bactericidal concentration (MBC) of the organism.…”

“…Tables 1 and 2 review those published case reports and studies regarding the use of IVT or IT aminoglycoside antibiotics in pediatric patients. Our initial dose of 2 mg was selected using previously published case reports [4][5][6][7][8][9] and studies. [10][11][12][13][14][15][16] Doses of IVT tobramycin ranging from 1.5-2 mg were used in our patient to achieve CSF concentrations of 20-30 µg/mL.…”

“…[10][11][12][13][14][15][16] Doses of IVT tobramycin ranging from 1.5-2 mg were used in our patient to achieve CSF concentrations of 20-30 µg/mL. The initial dose of 2 mg was selected using previously published case reports [4][5][6][7][8][9] and studies. [10][11][12][13][14][15][16] Similar to earlier reports, 8,11,14,16 we employed a CSF goal concentration of 20-30 µg/mL in order to achieve tobramycin concentrations that were at least five times the minimal inhibitory concentration (MIC) of the organism in the CSF (<4 µg/mL).…”

“…7 Unlike the MBC of 3.12 µg/mL reported by Pickering et al the gentamicin MIC of the or- CSF antibiotic concentrations and dosing requirements have been shown to vary based upon patient disease characteristics (e.g., hydrocephalus), type, and severity of infection. [4][5][6][7][8][9][10][11][12][13][14][15] Olsen and colleagues described a 6-month-old infant with hydrocephalus and a ventriculoperitoneal (VP) shunt who developed P aeruginosa ventriculitis. 6 Monotherapy with intramuscular (IM) and IVT gentamicin was initiated at a daily dose of 3 mg/ kg and 1 mg, respectively.…”

“…[4][5][6][7][8][9][10][11][12][13][14][15] Olsen and colleagues described a 6-month-old infant with hydrocephalus and a ventriculoperitoneal (VP) shunt who developed P aeruginosa ventriculitis. 6 Monotherapy with intramuscular (IM) and IVT gentamicin was initiated at a daily dose of 3 mg/ kg and 1 mg, respectively. After 12 days of therapy, the CSF cultures remained positive, and gentamicin was increased to 5 mg/kg IM and 3 mg IVT daily.…”