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J Neurol Surg A Cent Eur Neurosurg
DOI: 10.1055/a-2312-9276
Original Article

Clinical, Microbiological Profile, and Treatment Response to Intraventricular Antibiotics in the Management of Postneurosurgical Meningitis: A Single-Center Experience

Debajyoti Datta
1   Department of Neurosurgery, All India Institute of Medical Sciences – Bhubaneswar, Bhubaneswar, Orissa, India
,
Arunkumar Sekar 
2   Department of Neurosurgery, Sakra World Hospital, Bangalore, Karnataka, India
,
Amir Pasha
1   Department of Neurosurgery, All India Institute of Medical Sciences – Bhubaneswar, Bhubaneswar, Orissa, India
,
Ashis Patnaik
1   Department of Neurosurgery, All India Institute of Medical Sciences – Bhubaneswar, Bhubaneswar, Orissa, India
,
Rabi Narayan Sahu
1   Department of Neurosurgery, All India Institute of Medical Sciences – Bhubaneswar, Bhubaneswar, Orissa, India
,
Sumit Bansal
1   Department of Neurosurgery, All India Institute of Medical Sciences – Bhubaneswar, Bhubaneswar, Orissa, India
› Author Affiliations Funding None.
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Abstract

Background Postneurosurgical meningitis (PNM) is a serious medical condition with high mortality and morbidity caused by Gram positive organisms like Staphylococcus aureus and Gram-negative organisms like Acinetobacter baumannii. Optimum concentration of antibiotics in the cerebrospinal fluid (CSF) to treat these infections is difficult to achieve. Intraventricular antibiotic administration bypasses the blood–brain barrier and can achieve high CSF concentration without causing systemic toxicity.

Methods Retrospective review of all patient records were done to identify patients who developed postneurosurgical meningitis and received intraventricular antibiotic therapy during the period of July 2017 to December 2022. Demographic and clinical data along with the type of antibiotic, route, dose, and duration of administration were collected. CSF parameters before and after intraventricular antibiotic administration were collected and analyzed.

Results Twenty-six patients with postneurosurgical meningitis received intraventricular antibiotic therapy. Intracranial tumors were the most common underlying pathology followed by aneurysms. In all, 17/26 patients had received vancomycin and 9/26 patients had received colistin. External ventricular drain was used in 17/26 cases and Ommaya reservoir was used in 9/26 cases. Six patients showed growth of organism in CSF before starting intraventricular antibiotics, while one patient remained culture positive despite treatment. Of the 26 patients, 3 died despite treatment. There were significant changes in the CSF parameters after intraventricular antibiotic therapy.

Conclusion Intraventricular administration of antibiotic provides an alternative therapeutic option in the management of patients who are not responding or poorly responding to systemic antibiotics.

Keywords

intraventricular antibiotics - postoperative complication - intrathecal antibiotics

Patient Consent

Written informed consent was obtained from the patients for publication.


Authors' Contributions

A.S. conceived the study and reviewed the manuscript and was involved in patient care. D.D. and A.P. prepared the material and collected the data. A.Pat., S.B., and R.N.S. were involved in patient care and reviewing the manuscript.




Publication History

Received: 12 July 2023

Accepted: 22 April 2024

Accepted Manuscript online:
24 April 2024

Article published online:
20 August 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Lu CH, Chang WN, Chuang YC, Chang HW. The prognostic factors of adult gram-negative bacillary meningitis. J Hosp Infect 1998; 40 (01) 27-34
    CrossrefPubMedSearch in Google Scholar
  • 2 Wang KW, Chang WN, Huang CR. et al. Post-neurosurgical nosocomial bacterial meningitis in adults: microbiology, clinical features, and outcomes. J Clin Neurosci 2005; 12 (06) 647-650
    CrossrefPubMedSearch in Google Scholar
  • 3 Hussein K, Bitterman R, Shofty B, Paul M, Neuberger A. Management of post-neurosurgical meningitis: narrative review. Clin Microbiol Infect 2017; 23 (09) 621-628
    CrossrefPubMedSearch in Google Scholar
  • 4 Caricato A, Pennisi M, Mancino A. et al. Levels of vancomycin in the cerebral interstitial fluid after severe head injury. Intensive Care Med 2006; 32 (02) 325-328
    CrossrefPubMedSearch in Google Scholar
  • 5 Tunkel AR, Hasbun R, Bhimraj A. et al. Infectious Diseases Society of America's clinical practice guidelines for healthcare-associated ventriculitis and meningitis. Clin Infect Dis 2017; 64 (06) e34-e65
    CrossrefPubMedSearch in Google Scholar
  • 6 Remeš F, Tomáš R, Jindrák V, Vaniš V, Setlík M. Intraventricular and lumbar intrathecal administration of antibiotics in postneurosurgical patients with meningitis and/or ventriculitis in a serious clinical state. J Neurosurg 2013; 119 (06) 1596-1602
    CrossrefPubMedSearch in Google Scholar
  • 7 Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008; 36 (05) 309-332
    CrossrefPubMedSearch in Google Scholar
  • 8 Singh H, Patir R, Vaishya S, Miglani R, Kaur A. External ventricular drain related complications: whether continuous CSF drainage via Ommaya reservoir is the answer?. Neurol India 2020; 68 (02) 458-461
    CrossrefPubMedSearch in Google Scholar
  • 9 Mayhall CG, Archer NH, Lamb VA. et al. Ventriculostomy-related infections. A prospective epidemiologic study. N Engl J Med 1984; 310 (09) 553-559
    CrossrefPubMedSearch in Google Scholar
  • 10 Engelhardt B, Coisne C. Fluids and barriers of the CNS establish immune privilege by confining immune surveillance to a two-walled castle moat surrounding the CNS castle. Fluids Barriers CNS 2011; 8 (01) 4
    CrossrefPubMedSearch in Google Scholar
  • 11 Chen C, Zhang B, Yu S. et al. The incidence and risk factors of meningitis after major craniotomy in China: a retrospective cohort study. PLoS One 2014; 9 (07) e101961
    CrossrefPubMedSearch in Google Scholar
  • 12 Chen CH, Chang CY, Lin LJ. et al. Risk factors associated with postcraniotomy meningitis: a retrospective study. Medicine (Baltimore) 2016; 95 (31) e4329
    CrossrefPubMedSearch in Google Scholar
  • 13 Korinek AM, Baugnon T, Golmard JL, Effenterre R, Coriat P, Puybasset L. Risk factors for adult nosocomial meningitis after craniotomy role of antibiotic prophylaxis. Neurosurgery 2006; 59 (01) 126-133
    CrossrefPubMedSearch in Google Scholar
  • 14 Barker II FG. Efficacy of prophylactic antibiotics against meningitis after craniotomy: a meta-analysis. Neurosurgery 2007; 60 (05) 887-894 , discussion 887–894
    CrossrefPubMedSearch in Google Scholar
  • 15 Gaillard T, Gilsbach JM. Intra-operative antibiotic prophylaxis in neurosurgery. A prospective, randomized, controlled study on cefotiam. Acta Neurochir (Wien) 1991; 113 (3–4): 103-109
    CrossrefPubMedSearch in Google Scholar
  • 16 Alotaibi AF, Hulou MM, Vestal M. et al. The efficacy of antibacterial prophylaxis against the development of meningitis after craniotomy: a meta-analysis. World Neurosurg 2016; 90: 597-603.e1
    CrossrefPubMedSearch in Google Scholar
  • 17 Brown EM, de Louvois J, Bayston R, Lees PD, Pople IK. The management of neurosurgical patients with postoperative bacterial or aseptic meningitis or external ventricular drain-associated ventriculitis. Br J Neurosurg 2001; 14 (01) 7-12
    PubMedSearch in Google Scholar
  • 18 Ayhan M, Kalem AK, Hasanoglu I. et al. Intrathecal and intraventricular administration of antibiotics in gram-negative nosocomial meningitis in a research hospital in Turkey. Turk Neurosurg 2021; 31 (03) 348-354
    PubMedSearch in Google Scholar
  • 19 Sari ND, Baltali S, Serin I, Antar V. Evaluation of intraventricular/intrathecal antimicrobial therapy in the treatment of nosocomial meningitis caused by multidrug-resistant gram-negative bacteria after central nervous system surgery. Can J Infect Dis Med Microbiol 2021; 2021: 9923015
    PubMedSearch in Google Scholar
  • 20 Khan SA, Waqas M, Siddiqui UT. et al. Intrathecal and intraventricular antibiotics for postoperative gram-negative meningitis and ventriculitis. Surg Neurol Int 2017; 8: 226
    CrossrefPubMedSearch in Google Scholar
  • 21 Shofty B, Neuberger A, Naffaa ME. et al. Intrathecal or intraventricular therapy for post-neurosurgical gram-negative meningitis: matched cohort study. Clin Microbiol Infect 2016; 22 (01) 66-70
    CrossrefPubMedSearch in Google Scholar
  • 22 Karvouniaris M, Brotis AG, Tsiamalou P, Fountas KN. The role of intraventricular antibiotics in the treatment of nosocomial ventriculitis/meningitis from gram-negative pathogens: a systematic review and meta-analysis. World Neurosurg 2018; 120: e637-e650
    CrossrefPubMedSearch in Google Scholar
  • 23 Hu Y, He W, Yao D, Dai H. Intrathecal or intraventricular antimicrobial therapy for post-neurosurgical intracranial infection due to multidrug-resistant and extensively drug-resistant gram-negative bacteria: a systematic review and meta-analysis. Int J Antimicrob Agents 2019; 54 (05) 556-561
    CrossrefPubMedSearch in Google Scholar
  • 24 Wen DY, Bottini AG, Hall WA, Haines SJ. Infections in neurologic surgery. The intraventricular use of antibiotic. Neurosurg Clin N Am 1992; 12 (04) 471-478
    PubMedSearch in Google Scholar
  • 25 Imberti R, Iotti GA, Regazzi M. Intraventricular or intrathecal colistin for the treatment of central nervous system infections caused by multidrug-resistant gram-negative bacteria. Expert Rev Anti Infect Ther 2014; 12 (04) 471-478
    CrossrefPubMedSearch in Google Scholar
  • 26 Ng J, Gosbell IB, Kelly JA, Boyle MJ, Ferguson JK. Cure of multiresistant Acinetobacter baumannii central nervous system infections with intraventricular or intrathecal colistin: case series and literature review. J Antimicrob Chemother 2006; 58 (05) 1078-1081
    CrossrefPubMedSearch in Google Scholar
  • 27 Chusri S, Sakarunchai I, Kositpantawong N. et al. Outcomes of adjunctive therapy with intrathecal or intraventricular administration of colistin for post-neurosurgical meningitis and ventriculitis due to carbapenem-resistant Acinetobacter baumannii . Int J Antimicrob Agents 2018; 51 (04) 646-650
    CrossrefPubMedSearch in Google Scholar
  • 28 Falagas ME, Bliziotis IA, Tam VH. Intraventricular or intrathecal use of polymyxins in patients with gram-negative meningitis: a systematic review of the available evidence. Int J Antimicrob Agents 2007; 29 (01) 9-25
    CrossrefPubMedSearch in Google Scholar
  • 29 De Bonis P, Lofrese G, Scoppettuolo G. et al. Intraventricular versus intravenous colistin for the treatment of extensively drug resistant Acinetobacter baumannii meningitis. Eur J Neurol 2016; 23 (01) 68-75
    CrossrefPubMedSearch in Google Scholar