Current Practices of Intraventricular Antibiotic Therapy in the Treatment of Meningitis and Ventriculitis: Results from a Multicenter Retrospective Cohort Study

John J. Lewin, Aaron M. Cook, Cynthia Gonzales, David Merola, Ron Neyens, William J. Peppard, Gretchen M. Brophy, Lisa Kurczewski, Melissa Giarratano, Jason Makii, Anthony Rowe, Eljim P. Tesoro, Amber Zaniewski, Sarah Clark, Wendy C. Ziai

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Abstract

Background: Central nervous system (CNS) infections are particularly prevalent in the adult neurocritical care patient population and are associated with significant morbidity and mortality. Factors relevant to the nature of CNS infections pose significant challenges to clinicians treating afflicted patients. Intraventricular (IVT) administration of antibiotics may offer several benefits over systemic therapy; however, the outcomes and current practices of such treatments are poorly described in the literature. Objective: To describe current practices and outcomes of patients receiving intraventricular antibiotic treatment for CNS infections in neurological intensive care units of academic medical centers nationwide. Methods: A retrospective cohort study was conducted on patients admitted to intensive care units who received IVT antibiotic treatment at participating centers in the USA between January 01, 2003, and December 31, 2013. Clinical and laboratory parameters, microbiology, surgical and antimicrobial management, and treatment outcomes were collected and described. Results: Of the 105 patients included, all received systemic antimicrobial therapy along with at least one dose of IVT antimicrobial agents. Intraventricular vancomycin was used in 52.4% of patients. The average dose was 12.2 mg/day for a median duration of 5 days. Intraventricular aminoglycosides were used in 47.5% of the patients, either alone or in combination with IVT vancomycin. The average dose of gentamicin/tobramycin was 6.7 mg/day with a median duration of 6 days. Overall mortality was 18.1%. Cerebrospinal fluid (CSF) culture sterilization occurred in 88.4% of the patients with a rate of recurrence or persistence of positive cultures of 9.5%. Conclusion: Intraventricular antimicrobial agents resulted in a high CSF sterilization rate. Contemporary use of this route typically results in a treatment duration of less than a week. Prospective studies are needed to establish the optimal patient population, as well as the efficacy and safety of this route of administration.

Original languageEnglish (US)
Pages (from-to)609-616
Number of pages8
JournalNeurocritical Care
Volume30
Issue number3
DOIs
StatePublished - Jun 15 2019

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Meningitis
Cohort Studies
Retrospective Studies
Anti-Bacterial Agents
Central Nervous System Infections
Vancomycin
Therapeutics
Anti-Infective Agents
Intensive Care Units
Cerebrospinal Fluid
Tobramycin
Mortality
Aminoglycosides
Microbiology
Gentamicins
Population
Patient Care
Prospective Studies
Morbidity
Safety

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

Cite this

Current Practices of Intraventricular Antibiotic Therapy in the Treatment of Meningitis and Ventriculitis : Results from a Multicenter Retrospective Cohort Study. / Lewin, John J.; Cook, Aaron M.; Gonzales, Cynthia; Merola, David; Neyens, Ron; Peppard, William J.; Brophy, Gretchen M.; Kurczewski, Lisa; Giarratano, Melissa; Makii, Jason; Rowe, Anthony; Tesoro, Eljim P.; Zaniewski, Amber; Clark, Sarah; Ziai, Wendy C.

In: Neurocritical Care, Vol. 30, No. 3, 15.06.2019, p. 609-616.

Research output: Contribution to journalArticle

Lewin, JJ, Cook, AM, Gonzales, C, Merola, D, Neyens, R, Peppard, WJ, Brophy, GM, Kurczewski, L, Giarratano, M, Makii, J, Rowe, A, Tesoro, EP, Zaniewski, A, Clark, S & Ziai, WC 2019, 'Current Practices of Intraventricular Antibiotic Therapy in the Treatment of Meningitis and Ventriculitis: Results from a Multicenter Retrospective Cohort Study', Neurocritical Care, vol. 30, no. 3, pp. 609-616. https://doi.org/10.1007/s12028-018-0647-0
Lewin, John J. ; Cook, Aaron M. ; Gonzales, Cynthia ; Merola, David ; Neyens, Ron ; Peppard, William J. ; Brophy, Gretchen M. ; Kurczewski, Lisa ; Giarratano, Melissa ; Makii, Jason ; Rowe, Anthony ; Tesoro, Eljim P. ; Zaniewski, Amber ; Clark, Sarah ; Ziai, Wendy C. / Current Practices of Intraventricular Antibiotic Therapy in the Treatment of Meningitis and Ventriculitis : Results from a Multicenter Retrospective Cohort Study. In: Neurocritical Care. 2019 ; Vol. 30, No. 3. pp. 609-616.
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abstract = "Background: Central nervous system (CNS) infections are particularly prevalent in the adult neurocritical care patient population and are associated with significant morbidity and mortality. Factors relevant to the nature of CNS infections pose significant challenges to clinicians treating afflicted patients. Intraventricular (IVT) administration of antibiotics may offer several benefits over systemic therapy; however, the outcomes and current practices of such treatments are poorly described in the literature. Objective: To describe current practices and outcomes of patients receiving intraventricular antibiotic treatment for CNS infections in neurological intensive care units of academic medical centers nationwide. Methods: A retrospective cohort study was conducted on patients admitted to intensive care units who received IVT antibiotic treatment at participating centers in the USA between January 01, 2003, and December 31, 2013. Clinical and laboratory parameters, microbiology, surgical and antimicrobial management, and treatment outcomes were collected and described. Results: Of the 105 patients included, all received systemic antimicrobial therapy along with at least one dose of IVT antimicrobial agents. Intraventricular vancomycin was used in 52.4{\%} of patients. The average dose was 12.2 mg/day for a median duration of 5 days. Intraventricular aminoglycosides were used in 47.5{\%} of the patients, either alone or in combination with IVT vancomycin. The average dose of gentamicin/tobramycin was 6.7 mg/day with a median duration of 6 days. Overall mortality was 18.1{\%}. Cerebrospinal fluid (CSF) culture sterilization occurred in 88.4{\%} of the patients with a rate of recurrence or persistence of positive cultures of 9.5{\%}. Conclusion: Intraventricular antimicrobial agents resulted in a high CSF sterilization rate. Contemporary use of this route typically results in a treatment duration of less than a week. Prospective studies are needed to establish the optimal patient population, as well as the efficacy and safety of this route of administration.",
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AU - Cook, Aaron M.

AU - Gonzales, Cynthia

AU - Merola, David

AU - Neyens, Ron

AU - Peppard, William J.

AU - Brophy, Gretchen M.

AU - Kurczewski, Lisa

AU - Giarratano, Melissa

AU - Makii, Jason

AU - Rowe, Anthony

AU - Tesoro, Eljim P.

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N2 - Background: Central nervous system (CNS) infections are particularly prevalent in the adult neurocritical care patient population and are associated with significant morbidity and mortality. Factors relevant to the nature of CNS infections pose significant challenges to clinicians treating afflicted patients. Intraventricular (IVT) administration of antibiotics may offer several benefits over systemic therapy; however, the outcomes and current practices of such treatments are poorly described in the literature. Objective: To describe current practices and outcomes of patients receiving intraventricular antibiotic treatment for CNS infections in neurological intensive care units of academic medical centers nationwide. Methods: A retrospective cohort study was conducted on patients admitted to intensive care units who received IVT antibiotic treatment at participating centers in the USA between January 01, 2003, and December 31, 2013. Clinical and laboratory parameters, microbiology, surgical and antimicrobial management, and treatment outcomes were collected and described. Results: Of the 105 patients included, all received systemic antimicrobial therapy along with at least one dose of IVT antimicrobial agents. Intraventricular vancomycin was used in 52.4% of patients. The average dose was 12.2 mg/day for a median duration of 5 days. Intraventricular aminoglycosides were used in 47.5% of the patients, either alone or in combination with IVT vancomycin. The average dose of gentamicin/tobramycin was 6.7 mg/day with a median duration of 6 days. Overall mortality was 18.1%. Cerebrospinal fluid (CSF) culture sterilization occurred in 88.4% of the patients with a rate of recurrence or persistence of positive cultures of 9.5%. Conclusion: Intraventricular antimicrobial agents resulted in a high CSF sterilization rate. Contemporary use of this route typically results in a treatment duration of less than a week. Prospective studies are needed to establish the optimal patient population, as well as the efficacy and safety of this route of administration.

AB - Background: Central nervous system (CNS) infections are particularly prevalent in the adult neurocritical care patient population and are associated with significant morbidity and mortality. Factors relevant to the nature of CNS infections pose significant challenges to clinicians treating afflicted patients. Intraventricular (IVT) administration of antibiotics may offer several benefits over systemic therapy; however, the outcomes and current practices of such treatments are poorly described in the literature. Objective: To describe current practices and outcomes of patients receiving intraventricular antibiotic treatment for CNS infections in neurological intensive care units of academic medical centers nationwide. Methods: A retrospective cohort study was conducted on patients admitted to intensive care units who received IVT antibiotic treatment at participating centers in the USA between January 01, 2003, and December 31, 2013. Clinical and laboratory parameters, microbiology, surgical and antimicrobial management, and treatment outcomes were collected and described. Results: Of the 105 patients included, all received systemic antimicrobial therapy along with at least one dose of IVT antimicrobial agents. Intraventricular vancomycin was used in 52.4% of patients. The average dose was 12.2 mg/day for a median duration of 5 days. Intraventricular aminoglycosides were used in 47.5% of the patients, either alone or in combination with IVT vancomycin. The average dose of gentamicin/tobramycin was 6.7 mg/day with a median duration of 6 days. Overall mortality was 18.1%. Cerebrospinal fluid (CSF) culture sterilization occurred in 88.4% of the patients with a rate of recurrence or persistence of positive cultures of 9.5%. Conclusion: Intraventricular antimicrobial agents resulted in a high CSF sterilization rate. Contemporary use of this route typically results in a treatment duration of less than a week. Prospective studies are needed to establish the optimal patient population, as well as the efficacy and safety of this route of administration.

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