Infections of cerebrospinal fluid diversion devices in adults: The role of intraventricular antimicrobial therapy

• Published in: The Journal of infection Vol. 66; no. 3; pp. 239 - 246
• Main Authors: Wilkie, M.D, Hanson, M.F, Statham, P.F, Brennan, P.M
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Ltd 01-03-2013; Elsevier
• Subjects: Adolescent; Adult; Aged; Anti-Bacterial Agents - administration & dosage; Bacteria - classification; Bacteria - drug effects; Bacteria - isolation & purification; Bacterial Infections - cerebrospinal fluid; Bacterial Infections - drug therapy; Bacterial Infections - microbiology; Bacterial Infections - surgery; Biological and medical sciences; Cerebral Hemorrhage - surgery; Cerebrospinal fluid shunts; Cerebrospinal Fluid Shunts - adverse effects; Female; General aspects; Humans; Hydrocephalus; Hydrocephalus - surgery; Infectious Disease; Infusions, Intraventricular; Intraventricular antibiotic instillation; Male; Medical sciences; Middle Aged; Prosthesis-Related Infections - cerebrospinal fluid; Prosthesis-Related Infections - drug therapy; Prosthesis-Related Infections - microbiology; Prosthesis-Related Infections - surgery; Shunt infection; Treatment Outcome; Ventriculitis; Ventriculoperitoneal Shunt - adverse effects; Young Adult; Intraventricular antibiotic instillation; Hydrocephalus; Cerebrospinal fluid shunts; Shunt infection; Ventriculitis; Human; Infection; Treatment; Device; Adult; Cerebral ventricle; Cerebrospinal fluid; Antimicrobial agent
• ISSN: 0163-4453; 1532-2742
• DOI: 10.1016/j.jinf.2012.11.006

Summary Objectives The precise role for intraventricular (IVT) antimicrobials in combination with systemic antibiotics in management of cerebrospinal fluid (CSF) diversion device-associated infections is uncertain. We evaluated our current practice, comparing dual therapy against systemic antimicrobials alone. Methods All adult patients with at least two consecutive CSF isolates who were treated for CSF diversion device-related infection over a 5-year period (2005–2010) were identified retrospectively. Clinical and laboratory parameters, microbiology, surgical and antimicrobial management, and treatment outcomes were analysed. Results Forty-eight patients were identified – 25 received IVT and systemic antibiotics (group A), and 23 systemic antibiotics alone (group B). Clinical features were similar between groups, as were causative organisms. CSF leucocyte counts differed slightly ( A  >  B , p  = 0.067) but no laboratory parameters differed significantly. Infected devices were generally revised ( A  = 92%, B  = 91%). Mean times to CSF sterilisation and normalisation of CSF microscopy were significantly shorter for group A ( p  < 0.05 and p  < 0.005 respectively), as was duration of hospital stay ( p  < 0.002) and required length of systemic antimicrobial therapy ( p  < 0.001). Conclusions Our findings indicate that IVT antibiotics enhance clinical and microbiological recovery and should therefore be considered for patients with CSF infection associated with a CSF diversion device. We recommend further evaluation of this approach in a prospective, randomised, controlled trial.