title: Infections of cerebrospinal fluid diversion devices in adults: the role of intraventricular antimicrobial therapy.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Clinical Neurosciences, Western General Hospital Crewe Road South, Edinburgh EH4 2XU, UK. mdwilkie@doctors.org.uk
authors.forename: M D
authors.initials: MD
authors.lastname: Wilkie
authors.forename: M F
authors.initials: MF
authors.lastname: Hanson
authors.forename: P F
authors.initials: PF
authors.lastname: Statham
authors.forename: P M
authors.initials: PM
authors.lastname: Brennan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001419:Bacteria / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D001424:Bacterial Infections / Q000134:cerebrospinal fluid / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery; D002543:Cerebral Hemorrhage / Q000601:surgery; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery; D057967:Infusions, Intraventricular; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000134:cerebrospinal fluid / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents