title: Adjunctive intraventricular antibiotic therapy for bacterial central nervous system infections in critically ill patients with traumatic brain injury.
abstract: BACKGROUND
  Limited data exist on the role of adjunctive intraventricular (IVT) antibiotics for the treatment of central nervous system (CNS) infections in traumatic brain injury (TBI) patients.
  
  
  OBJECTIVE
  To evaluate differences in CNS infection cure rates for TBI patients who received adjunctive IVT antibiotics compared with intravenous (IV) antibiotics alone.
  
  
  METHODS
  We retrospectively identified patients with TBI and bacterial CNS infections admitted to the trauma intensive care unit (ICU) from 1997 to 2013. Study patients received IV and IVT antibiotics, and control patients received IV antibiotics alone. Clinical and microbiological cure rates were determined from patient records, in addition to ICU and hospital lengths of stay (LOSs), ventilator days, and hospital mortality.
  
  
  RESULTS
  A total of 83 patients were enrolled (32 study and 51 control). The duration of IV antibiotics was similar in both groups (10 vs 12 days, P = 0.14), and the study group received IVT antibiotics for a median of 9 days. Microbiological cure rates were 84% and 82% in study and control groups, respectively (P = 0.95). Clinical cure rates were similar at all time points. No significant differences were seen in days of mechanical ventilation, ICU or hospital LOS, or hospital mortality. When only patients with external ventricular drains were compared, cure rates remained similar between groups.
  
  
  CONCLUSIONS
  TBI patients with CNS infections had similar microbiological and clinical cure rates whether they were treated with adjunctive IVT antibiotics or IV antibiotics alone. Shorter than recommended durations of antibiotic therapy still resulted in acceptable cure rates and similar clinically relevant outcomes.
authors.affiliation: University of Tennessee College of Pharmacy, Memphis, TN, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: McClellan
authors.affiliation: University of Tennessee College of Pharmacy, Memphis, TN, USA jswanson@uthsc.edu.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Swanson
authors.affiliation: University of Tennessee College of Medicine, Memphis, TN, USA.
authors.forename: Louis J
authors.initials: LJ
authors.lastname: Magnotti
authors.affiliation: Accredo, an Express Scripts Specialty Pharmacy, Memphis, TN, USA.
authors.forename: Terry W
authors.initials: TW
authors.lastname: Griffith
authors.affiliation: University of Tennessee College of Pharmacy, Memphis, TN, USA.
authors.forename: G Christopher
authors.initials: GC
authors.lastname: Wood
authors.affiliation: University of Tennessee College of Medicine, Memphis, TN, USA.
authors.forename: Martin A
authors.initials: MA
authors.lastname: Croce
authors.affiliation: University of Tennessee College of Pharmacy, Memphis, TN, USA.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Boucher
authors.affiliation: UC Health/University of Cincinnati Medical Center, Cincinnati, OH, USA.
authors.forename: Eric W
authors.initials: EW
authors.lastname: Mueller
authors.affiliation: University of Tennessee College of Medicine, Memphis, TN, USA.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Fabian
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001930:Brain Injuries / Q000150:complications* / Q000401:mortality; D016022:Case-Control Studies; D002494:Central Nervous System Infections / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D016638:Critical Illness; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D057967:Infusions, Intraventricular; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents
keywords: intrathecal antibiotics; intraventricular antibiotics; meningitis; traumatic brain injury