Ventriculitis: A Severe Complication of Central Nervous System Infections

Abstract

Background Ventriculitis, a dreaded complication of brain abscess, meningitis, and various neurosurgical procedures, has attracted limited attention in the medical literature. Methods Retrospective single-centre study. We screened medical files of all patients who had a brain imaging report including the word “ventriculitis” during years 2005-2019. Only patients with clinical, microbiological and imaging features of ventriculitis were included. Data were collected through a standardized questionnaire. Results Ninety-eight patients fulfilled inclusion criteria: 42 women and 56 men, median age 60 years [interquartile range 48-68]. Primary mechanism for ventriculitis was classified as follows: brain abscess (n=29, 29.6%), meningitis (n=27, 27.6%), intraventricular catheter-related (n=17, 17.3%), post-neurosurgery (n=13, 13.3%), and hematogenous (n=12, 12.2%). Main neuroimaging features were intraventricular pus (n=81, 82.7%), ependymal enhancement (n=70, 71.4%) and intraventricular loculations (n=15, 15.3%). Main pathogens were streptococci (n=44, 44.9%), Gram-negative bacilli (n=27, 27.6%), and staphylococci (n=15, 15.3%). In-hospital and one-year mortality rates were, respectively, 30.6% (n=30), and 38.8% (n=38). Neurological sequelae were reported in 34/55 (61.8%) survivors, including cognitive impairment (n=11), gait disturbances (n=9), paresis (n=7), behavior disorder (n=6), epilepsy (n=5). On multivariate analysis, age > 65 years, Glasgow Coma Scale score < 13 at initial presentation, status epilepticus, hydrocephalus and positive cerebrospinal fluid culture were associated with one-year mortality. We built a scoring system to stratify patients with ventriculitis into low-risk (12.5%), intermediate-risk (36.5%), and high-risk (71.4%) of death. Conclusion Ventriculitis is a severe complication of brain abscess, meningitis, or neurosurgery, with in-hospital mortality rate of 30%, and neurological sequelae in 60% of survivors.

Trends of Antimicrobial Susceptibility in Clinically Significant Coagulase-Negative Staphylococci Isolated from Cerebrospinal Fluid Cultures in Neurosurgical Adults: a Nine-Year Analysis

“…An infected episode was defined as a patient who had clinical features of HCAVM ( 22 ) and an improvement related to a susceptible antimicrobial agent. However, the therapeutic effect of the susceptible antimicrobial agent alone could be deficient in patients with special situations, including poor wound healing ( 26 ), implants ( 27 ), CSF leakage ( 28 ), abscess ( 29 ), and ventriculitis ( 30 ). For episodes with two or more positive cultures, the first positive culture was analyzed ( 25 ).…”

Ventriculitis: Infection or Inflammation

“…Ventriculitis is associated with high rates of mortality and morbidity [1,12]. A recent, large case series demonstrated a mortality rate of 30% among patients with ventriculitis, though that cohort included patients without EVDs as well [2]. It is important to recognize that ventriculitis occurs in patients who are at elevated risk of mortality due to their underlying neurocritical condition (such as subarachnoid hemorrhage, traumatic brain injury); therefore, mortality in these patients is attributable to many reasons, one of which is ventriculitis.…”

“…Ventriculitis complicating EVD insertion is associated with significantly longer hospital length of stay and cost of healthcare [13]. The risk of neurological impairment among survivors has increased five-fold [13], with Luque-Paz et al [2] reporting persistent, longterm neurological impairment in 62% of patients. Deficits included cognitive disorder, seizures, gait disturbance, fatigue, and memory loss.…”

“…Cerebrospinal fluid (CSF) infections in the setting of neurosurgery and intracranial devices, such as external ventricular drains (EVD), intracranial pressure monitors, and CSF shunts, are an important and common complication [1] with significant associated mortality and morbidity [2]. These CSF infections are referred to as healthcare-associated ventriculitis and meningitis (referred to as "ventriculitis" in this review), as opposed to community-acquired meningitis, which refers to CSF infection in the absence of intracranial devices and neurosurgery [3].…”

Efficacy of Vancomycin and Meropenem in Central Nervous System Infections in Children and Adults: Current Update

“…In a recent study on bacterial meningitis in adults, the in-hospital mortality for patients with community-acquired or healthcare-related meningitis was 10.6%, which increased to 14.8% at three months after discharge [ 6 ]. Ventriculitis, also accounted among the CNS infections, is a severe complication of meningitis and brain abscess that frequently occurs after neurosurgical procedures [ 2 , 7 ]. A recent study found that ventriculitis has an in-hospital mortality rate of 30% and leads to neurological sequelae in 60% of survivors, highlighting the severity of this type of infection [ 7 ].…”