The Role of Endoscopic Lavage in Recalcitrant Multidrug-Resistant Gram-Negative Ventriculitis Among Neurosurgical Patients.
BACKGROUND
Ventriculitis is a serious infection associated with high mortality even when both intravenous (IV) and intrathecal (IT) antibiotics are administered. Poor outcome in patients with ventriculitis indicates the need to be more aggressive in our attempts to expeditiously eradicate the infection. The purpose of this study was to evaluate the role of endoscopic lavage (EL) in patients with severe purulent ventriculitis, unresponsive to IV and IT antibiotics.


METHODS
All consecutive patients with severe ventriculitis caused by multidrug-resistant gram-negative bacteria, undergoing EL after failure of prolonged courses of IV and IT antibiotics, were included in the study. The outcome in all these patients was otherwise expected to be uniformly dismal.


RESULTS
There were 5 males and 2 females. The age range was one month to 45 years. All patients had frank intraventricular pus. Acinetobacter baumannii was the most common organism grown in cultures. Two patients had multiple bacterial growth in cerebrospinal fluid cultures. The duration of pre-EL IV/IT antibiotics ranged from 3 to 8 weeks. Microbiological cure was achieved in all (7/7) and clinical cure in 86% of patients (6/7). One patient died despite achieving cerebrospinal fluid sterilization 3 months later as a result of progressive white matter edema.


CONCLUSIONS
The addition of IT antibiotics has resulted in improved outcome in patients with ventriculitis; however, some patients continue to be unresponsive to antibiotics. EL can play a complementary role in eradicating such recalcitrant infections. EL should be considered in any patient with ventriculitis, if infection persists even after ∼7-10 days of IVand IT antibiotics.
Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India. Electronic address: aman_jagdevan@yahoo.co.in.
Amandeep
A
Kumar
Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
Deepak
D
Agrawal
Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
Bhawani S
BS
Sharma
D000151:Acinetobacter Infections / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D058565:Cerebral Ventriculitis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D003131:Combined Modality Therapy / Q000379:methods; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000379:methods*; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D007507:Therapeutic Irrigation / Q000379:methods*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents
Endoscopic lavage; Multidrug-resistant gram-negative bacteria; Severe; Ventriculitis