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Condos AM, Wangaryattawanich P, Rath TJ. Bacterial, Viral, and Prion Infectious Diseases of the Brain. Magn Reson Imaging Clin N Am 2024; 32:289-311. [PMID: 38555142 DOI: 10.1016/j.mric.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Diagnosis of brain infections is based on a combination of clinical features, laboratory markers, and imaging findings. Imaging characterizes the extent and severity of the disease, aids in guiding diagnostic and therapeutic procedures, monitors response to treatment, and demonstrates complications. This review highlights the characteristic imaging manifestations of bacterial and viral infections in the brain.
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Affiliation(s)
- Amy M Condos
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA.
| | - Pattana Wangaryattawanich
- Department of Radiology, University of Washington School of Medicine, 1959 Northeast Pacific Street, Seattle, WA 98195-7115, USA
| | - Tanya J Rath
- Neuroradiology Section, Department of Radiology, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
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Fernandez V JP, Acosta G N, Flores S T, Fernández G. Measurement of cerebrospinal fluid lactate levels in pediatric patients with suspected ventriculoperitoneal shunt infection: A retrospective cohort study. Clin Neurol Neurosurg 2024; 240:108256. [PMID: 38547629 DOI: 10.1016/j.clineuro.2024.108256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 04/29/2024]
Abstract
INTRODUCTION Ventriculoperitoneal shunt (VPS) infection is a severe complication. Early diagnosis could help to decrease morbidity and treatment costs. Lactate has been used for the diagnosis of other central nervous system infections. The aim of this study is to determine the usefulness of lactate for the diagnosis of VPS infection. METHODOLOGY Retrospective cohort study. Lactate was measured in patients who consulted with VPS dysfunction between May 2019 and May 2022. Mean were compared according to culture results. A Receiver Operating Characteristic (ROC) curve was performed to determine the appropriate cut-off point. RESULT Lactate has a high negative predictive value but a low positive predictive value for the diagnosis of ventriculitis.
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Affiliation(s)
- Jose Pablo Fernandez V
- Pediatrician, Chile; Pediatric Intensive Care Unit. Instituto de Neurocirugía Asenjo. Santiago, Chile.
| | - Natalia Acosta G
- Pediatrician, Chile; Pediatric Intensive Care Unit. Instituto de Neurocirugía Asenjo. Santiago, Chile
| | - Tamara Flores S
- Neurosurgeon, Chile; Pediatric Intensive Care Unit. Instituto de Neurocirugía Asenjo. Santiago, Chile
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Li Z, Yang W, Ye X, Yuan Q, Zhao J, Du Z, Yu J, Sun Y, Wu X, Hu J. Early Intraventricular Antibiotic Therapy Improved In-Hospital-Mortality in Neurocritical Patients with Multidrug-Resistant Bacterial Nosocomial Meningitis and Ventriculitis. Neurocrit Care 2024; 40:612-620. [PMID: 37498458 DOI: 10.1007/s12028-023-01781-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 06/09/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Hospital-acquired multidrug-resistant (MDR) bacterial meningitis and/or ventriculitis (MEN) is a severe condition associated with high mortality. The risk factors related to in-hospital mortality of patients with MDR bacterial MEN are unknown. We aimed to examine factors related to in-hospital mortality and evaluate their prognostic value in patients with MDR bacterial MEN treated in the neurointensive care unit. METHODS This was a single-center retrospective cohort study of critically ill neurosurgical patients with MDR bacterial MEN admitted to our hospital between January 2003 and March 2021. Data on demographics, admission variables, treatment, time to start of intraventricular (IVT) therapy, and in-hospital mortality were analyzed. Both univariate and multivariable analyses were performed to identify determinants of in-hospital mortality. RESULTS All 142 included patients received systemic antibiotic therapy, and 102 of them received concomitant IVT treatment. The median time to start of IVT treatment was 2 days (interquartile range 1-5 days). The time to start of IVT treatment had an effect on in-hospital mortality (hazard ratio 1.17; 95% confidence interval 1.02-1.34; adjusted p = 0.030). The cutoff time to initiate IVT treatment was identified at 3 days: patients treated within 3 days had a higher cerebrospinal fluid (CSF) sterilization rate (81.5%) and a shorter median time to CSF sterilization (7 days) compared with patients who received delayed IVT treatment (> 3 days) (48.6% and 11.5 days, respectively) and those who received intravenous antibiotics alone (42.5% and 10 days, respectively). CONCLUSIONS Early IVT antibiotics were associated with superior outcomes in terms of the in-hospital mortality rate, time to CSF sterilization, and CSF sterilization rate compared with delayed IVT antibiotics and intravenous antibiotics alone.
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Affiliation(s)
- Zhiqi Li
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Middle Wulumuqi Road 12#, Jing'an District, Shanghai, 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
| | - Weijian Yang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Middle Wulumuqi Road 12#, Jing'an District, Shanghai, 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
| | - Xiangru Ye
- Neuro-intensive Care Unit, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qiang Yuan
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Middle Wulumuqi Road 12#, Jing'an District, Shanghai, 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
| | - Jianlan Zhao
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Middle Wulumuqi Road 12#, Jing'an District, Shanghai, 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
| | - Zhuoying Du
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Middle Wulumuqi Road 12#, Jing'an District, Shanghai, 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
| | - Jian Yu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Middle Wulumuqi Road 12#, Jing'an District, Shanghai, 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
| | - Yirui Sun
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Middle Wulumuqi Road 12#, Jing'an District, Shanghai, 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
| | - Xuehai Wu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Middle Wulumuqi Road 12#, Jing'an District, Shanghai, 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
| | - Jin Hu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Middle Wulumuqi Road 12#, Jing'an District, Shanghai, 200040, China.
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China.
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.
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Valdivia DAP, Pérez EAH, Vega LRZ, García JMH, Herrera KV. Systematic review and meta-analysis of intraventricular antibiotics for neonatal meningitis and ventriculitis. Childs Nerv Syst 2024; 40:1019-1030. [PMID: 38015250 DOI: 10.1007/s00381-023-06240-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 11/21/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE We aimed to determine the safety and effectiveness of intraventricular antibiotics in neonates with meningitis and/or ventriculitis and analyze the quality of available evidence. METHODS DESIGN: Systematic review and meta-analysis. DATA SOURCES PubMed, EMBASE, LILACS, and SCOPUS up to 17 February 2023. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomized experimental and observational studies were included. The Cochrane methodology was used for systematic reviews. RESULTS Twenty-six observational studies and one randomized clinical trial involving 272 patients were included. The risk of bias in both pediatric and neurosurgical studies was high, and the quality of evidence was low (evidence level C). In the pediatric studies, no significant differences in mortality were found between intraventricular antibiotics and only systemic antibiotic [25.4% vs 16.1%, OR = 0.96 (0.42-2.24), P = 0.93]. However, when analyzing the minimum administered doses, we found a lower mortality when a minimum duration of 3 days for intraventricular antibiotics was used compared to only systemic antibiotic [4.3% vs 17%, OR = 0.22 (0.07-0.72), P = 0.01]. In the neurosurgical studies, the use of intraventricular antibiotics in ventriculitis generally results in a mortality of 5% and a morbidity of 25%, which is lower than that in cases where intraventricular antibiotics were not used, with an average mortality of 37.3% and a morbidity of 50%. CONCLUSION Considering the low quality of evidence in pediatric and neurosurgical studies, we can conclude with a low level of certainty that intraventricular antibiotics may not significantly impact mortality in neonatal meningitis and ventriculitis. However, reduced mortality was observed in cases treated with a minimum duration of 3 days of intraventricular antibiotic, particularly the multidrug-resistant or treatment-refractory infections. Higher-quality studies are needed to improve the quality of evidence and certainty regarding the use of intraventricular antibiotics for treating neonatal meningitis and ventriculitis.
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Affiliation(s)
| | | | | | | | - Karen Vanessa Herrera
- Quality Department, Military Hospital "Dr Alejandro Dávila Bolaños", Managua, Nicaragua
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Volpicelli L, Cairoli S, Al Ismail D, Baisi F, Sacco F, Goffredo BM, Venditti M, Oliva A. Simultaneous post-neurosurgical ventriculitis and bacteraemia by two different strains of KPC-producing K. pneumoniae successfully treated with meropenem/vaborbactam and high dose of fosfomycin. J Glob Antimicrob Resist 2024; 37:86-90. [PMID: 38519025 DOI: 10.1016/j.jgar.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/10/2024] [Accepted: 03/09/2024] [Indexed: 03/24/2024] Open
Abstract
OBJECTIVE A case of post-neurosurgical ventriculitis caused by a KPC-producing Klebsiella pneumoniae (KPC-Kp) with a ceftazidime/avibactam-resistant, meropenem-susceptible phenotype is reported. METHODS AND RESULTS The patient had a concomitant bloodstream infection with a wild-type KPC-Kp with a ceftazidime/avibactam-susceptible, meropenem-resistant phenotype. Prolonged treatment with intravenous fosfomycin and meropenem/vaborbactam achieved clinical success. Therapeutic drug monitoring performed during the first days of treatment showed for the first time that vaborbactam efficiently penetrates cerebrospinal fluid. In contrast, meropenem was undetectable in cerebrospinal fluid at each sampling, suggesting that additional doses of meropenem may be required to appropriately prescribe meropenem/vaborbactam for central nervous system infections. Plasma and cerebrospinal fluid levels of fosfomycin were adequate, confirming the potential of this agent possibly even in the fight against multidrug-resistant organisms. CONCLUSIONS This case highlights the need for therapeutic drug monitoring as a crucial tool for optimizing treatment in complicated cases where the pharmacokinetic behaviour of antibiotics is difficult to predict.
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Affiliation(s)
- Lorenzo Volpicelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Sara Cairoli
- Division of Metabolic Diseases and Drug Biology, Department of Pediatric Specialties and Liver-Kidney Transplantation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Dania Al Ismail
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Floriana Baisi
- Department of General and Specialistic Surgery, Sapienza University of Rome, Rome, Italy
| | - Federica Sacco
- Microbiology and Virology Laboratory, Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Bianca Maria Goffredo
- Division of Metabolic Diseases and Drug Biology, Department of Pediatric Specialties and Liver-Kidney Transplantation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
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Policicchio D, Cosco L, Mauro G, Iannello AN, Santaguida L, Vescio V, Dipellegrini G. Stereotactic placement of dual lumen catheter system for continuous drainage, irrigation, and intraventricular antibiotic therapy for treatment of brain abscess with ventriculitis - A case report and literature review. Surg Neurol Int 2024; 15:57. [PMID: 38468682 PMCID: PMC10927178 DOI: 10.25259/sni_977_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/22/2024] [Indexed: 03/13/2024] Open
Abstract
Background Cerebral abscesses complicated by ventriculitis present significant treatment challenges, often associated with high morbidity and mortality. Traditional management approaches, including systemic antibiotic therapy and external ventricular drainage (EVD), face limitations due to the blood-brain barrier and risks of catheter-related complications. This report discusses a case where the dual-lumen catheter system, an innovative neurosurgical tool integrating continuous irrigation with drainage, was employed. Case Description A patient presented with a cerebral abscess ruptured into the ventricle, leading to ventriculitis. Conventional treatment options were limited due to the abscess's deep and eloquent location and the associated risk of complications from standard EVD. The dual lumen system was chosen for its ability to provide continuous irrigation and drainage, effectively addressing issues of catheter blockage and enhancing localized antibiotic delivery. The system was used to create a single stereotactic tract for simultaneous treatment of the abscess and ventriculitis. This approach allowed for a more controlled and effective treatment process, resulting in rapid resolution of the conditions without chronic hydrocephalus development or further complications. Conclusion The use of the dual lumen system represented a significant advancement in this case, addressing the limitations of conventional treatments. Its ability to maintain intracranial pressure within optimal limits while providing localized, continuous treatment was pivotal. This case highlights the potential of the dual lumen catheter in managing complex neurosurgical infections and underscores the need for further research to establish its efficacy in broader clinical applications.
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Affiliation(s)
- Domenico Policicchio
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Renato Dulbecco di Catanzaro, Catanzaro, Italy
| | - Lucio Cosco
- Unit of Infectious and Tropical Diseases, Azienda Ospedaliero Universitaria “Renato Dulbecco” di Catanzaro, Catanzaro, Italy
| | - Giuseppe Mauro
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Renato Dulbecco di Catanzaro, Catanzaro, Italy
| | - Alfonso Nicola Iannello
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Renato Dulbecco di Catanzaro, Catanzaro, Italy
| | - Luigi Santaguida
- Unit of Biomedical Engineering, Azienda Ospedaliero Universitaria “Renato Dulbecco” di Catanzaro, Catanzaro, Italy
| | - Virginia Vescio
- Department of Radiology, Azienda Ospedaliero Universitaria “Renato Dulbecco” di Catanzaro, Catanzaro, Italy
| | - Giosué Dipellegrini
- Department of Neurosurgery, Azienda Ospedaliero Universitaria di Sassari, Sassari, Italy
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Huang TF, Su YK, Su IC, Yeh YK, Liu HW, Kan IH, Lu YC, Chang YP, Lin CM, Tu YK, Tseng CH. Risk, Predictive, and Preventive Factors for Noninfectious Ventriculitis and External Ventricular Drain Infection. Neurocrit Care 2024:10.1007/s12028-023-01925-9. [PMID: 38253924 DOI: 10.1007/s12028-023-01925-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/14/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND External ventricular drain (EVD) is used for monitoring intracranial pressure or diverting cerebrospinal fluid. However, confirmation of an infection is not immediate and requires obtaining culture results, often leading to the excessive use of antibiotics. This study aimed to compare noninfectious ventriculitis and EVD infection in terms of the risk factors, predictors, prognosis, and effectiveness of care bundle interventions. METHODS This retrospective study was conducted at a medical center with 1,006 beds in northern Taiwan between January 2018 and July 2022. Standard EVD insertion protocols and care bundles have been implemented since 2018, along with the initiation of chlorhexidine. RESULTS In total, 742 EVD cases were identified. Noninfectious ventriculitis typically presents with fever approximately 8 days following EVD placement, whereas EVD infection typically manifests as fever after 20 days. Aneurysmal subarachnoid hemorrhage was strongly associated with the development of noninfectious ventriculitis (adjusted odds ratio [OR] 2.6, 95% confidence interval [CI] 1.5-4.4). Alcoholism (adjusted OR 3.5, 95% CI 1.1-12.3) and arteriovenous malformation (adjusted OR 13.1, 95% CI 2.9-58.2) significantly increased the risk of EVD infection. The EVD infection rate significantly decreased from 3.6% (14 of 446) to 1.0% (3 of 219) (p = 0.03) after the implementation of chlorhexidine gluconate bathing. CONCLUSIONS Aneurysmal subarachnoid hemorrhage or fever with neuroinflammation within 2 weeks of EVD placement is indicative of a higher likelihood of noninfectious ventriculitis. Conversely, patients with arteriovenous malformation, alcoholism, or fever with neuroinflammation occurring after more than 3 weeks of EVD placement are more likely to necessitate antibiotic treatment for EVD infection. Chlorhexidine gluconate bathing decreases EVD infection.
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Affiliation(s)
- Tzu-Fen Huang
- Division of Neurosurgery, Department of Surgical Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yu-Kai Su
- Division of Neurosurgery, Department of Surgical Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, Taipei Medical University, Taipei, Taiwan
| | - I-Chang Su
- Division of Neurosurgery, Department of Surgical Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yun-Kai Yeh
- Division of Critical Care Medicine, Department of Emergency and Critical Care Medicine, Shuang Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd., Zhonghe District, New Taipei City, Taiwan
| | - Heng-Wei Liu
- Division of Neurosurgery, Department of Surgical Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, Taipei Medical University, Taipei, Taiwan
| | - I-Hung Kan
- Division of Neurosurgery, Department of Surgical Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Chun Lu
- Division of Neurosurgery, Department of Surgical Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
| | - Yu-Pei Chang
- Department of Nursing, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chien-Min Lin
- Division of Neurosurgery, Department of Surgical Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yong-Kwang Tu
- Division of Neurosurgery, Department of Surgical Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chien-Hua Tseng
- Division of Critical Care Medicine, Department of Emergency and Critical Care Medicine, Shuang Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd., Zhonghe District, New Taipei City, Taiwan.
- Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.
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Fernandez A, Uvelius E, Kronvall E. Ventriculostomy-Related Infections: Reduced Incidence by Terminating Cerebrospinal Fluid Screening. World Neurosurg 2024; 181:e820-e825. [PMID: 37923016 DOI: 10.1016/j.wneu.2023.10.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND The external ventricular drain (EVD) is an important instrument in managing patients in neurointensive care (NICU). A frequent and sometimes severe complication is ventriculostomy-related infection (VRI). This study aimed to evaluate the effects of biweekly VRI screening by CSF sampling on the clinical course and rate of VRI. METHODS Patients with implanted EVDs were retrospectively identified and a cohort screened twice per week was compared with a cohort sampled only on clinical indication. VRI was defined either as a suspected case or a culture-confirmed case. Length of stay in the NICU and CSF shunt dependency were used as outcome parameters. RESULTS A total of 562 patients were included. The overall proportion of patients treated for VRI was 22% and was not affected by screening (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.57-1.54). Screening was associated with a higher proportion of patients with culture-confirmed VRI (OR, 2.86; 95% CI, 1.36-6.73). The main risk factor for VRI was the number of days with EVD. Positive bacterial culture was associated with both a longer time in the NICU (β = 3.6; P < 0.01) and higher risk for shunt surgery (OR, 1.95; 95% CI, 1.04-3.64). CONCLUSIONS Screening was associated with a higher number of culture-confirmed VRI cases. In addition, screening did not detect VRI at an earlier stage and was not associated with a reduction in the rate of permanent hydrocephalus. No clinical benefit of screening was found. Frequent CSF sampling might contribute to infection. Based on these findings, CSF screening for VRI cannot be recommended.
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Affiliation(s)
- Antonio Fernandez
- Department of Neurosurgery, Skåne University Hospital, Lund, Sweden.
| | - Erik Uvelius
- Department of Neurosurgery, Skåne University Hospital, Lund, Sweden
| | - Erik Kronvall
- Department of Neurosurgery, Skåne University Hospital, Lund, Sweden
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Valdivia DAP, Vega LRZ, Pérez EAH. Intraventricular endoscopy and intraventricular antibiotics in the treatment of multiloculated hydrocephalus with ventriculitis in a neonate and an infant: Two case reports. Surg Neurol Int 2023; 14:354. [PMID: 37941630 PMCID: PMC10629316 DOI: 10.25259/sni_428_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 09/12/2023] [Indexed: 11/10/2023] Open
Abstract
Background We present two pediatric cases, a neonate and an infant, who presented with treatment-refractory ventriculitis and multiloculated hydrocephalus treated with simultaneous intraventricular endoscopy and antibiotics. This is the first report of this combined therapy in children. Case Description Using intraventricular endoscopic surgery and antibiotics, hydrocephalus was treated with a minimum number of ventricular shunt systems. In addition, treatment-refractory ventriculitis was treated in both patients using intraventricular antibiotics. Conclusion Endoscopic surgery and intraventricular antibiotic administration are useful strategies for treating multiloculated hydrocephalus and ventriculitis in children.
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Hect JL, Sefcik RK, Nowicki KW, Katz J, Greene S. Serial Neuroendoscopic Lavage for the Treatment of Elevated Cerebrospinal Fluid Protein Levels in Infants with Gram-Negative Rod Ventriculitis. Pediatr Neurosurg 2023; 58:401-409. [PMID: 37703859 DOI: 10.1159/000534083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/08/2023] [Indexed: 09/15/2023]
Abstract
INTRODUCTION Gram-negative rod (GNR) bacterial ventriculitis is a rare complication of shunt-dependent hydrocephalus, often requiring an extended and invasive treatment course. Accumulation of purulent material, as well as empyema and septation formation, limits circulation of antibiotics and infection clearance. Supplementation of standard care with neuroendoscopic-guided intraventricular lavage with lactated Ringer solution and fenestration of septations may facilitate infection clearance and simplify the eventual shunt construct required. Here, the utility of serial lavage for ventriculitis is described in a population of shunt-dependent neonates and infants at high risk for morbidity and mortality. METHODS Five infants with shunt-dependent hydrocephalus and subsequent GNR ventriculitis were treated with standard care measures with the addition of serial neuroendoscopic lavage. A retrospective chart review was performed to collect patient characteristics, shunt dependency, and shunt revisions within a year of ventriculitis resolution. RESULTS Patients demonstrated a mean 74% decrease in cerebrospinal fluid (CSF) protein following each neuroendoscopic lavage and trended toward a shorter time to infection clearance in comparison to previously published literature. Patients required 0-2 shunt revisions at 1-year follow-up following hospitalization for shunt-related ventriculitis (mean 0.8 +/- 0.8). CONCLUSIONS Serial neuroendoscopic lavage is an effective technique, used alone or in combination with fenestration of septations, to reduce the CSF protein and bacterial load in the treatment of ventriculitis, decreasing time until eradication of infection. Serial lavage may reduce the risk of future shunt malfunction, simplify the future shunt construct, and decrease duration of infection.
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Affiliation(s)
- Jasmine L Hect
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Roberta K Sefcik
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kamil W Nowicki
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Joel Katz
- Department of Pediatric Neurosurgery, Akron Children's Hospital, Akron, Ohio, USA
| | - Stephanie Greene
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Neurological Surgery, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Doub JB, Chua JV. A rare case of Sphingomonas paucimobilis ventriculitis. Germs 2023; 13:254-258. [PMID: 38146376 PMCID: PMC10748845 DOI: 10.18683/germs.2023.1391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/18/2023] [Accepted: 07/09/2023] [Indexed: 12/27/2023]
Abstract
Introduction Nosocomial ventriculitis is a severe infection that habitually plagues neurological intensive care units. It is usually associated with external ventricular drains. Unfortunately, classic cerebral spinal fluid parameters are less specific and sensitive compared to community acquired meningitis. This is in part secondary to indolent bacteria commonly infecting external ventricular drains leading to ventriculitis. Case report Herein, a rare case of Sphingomonas paucimobilis ventriculitis in an immunocompetent host is reported. The patient had classic symptoms of ventriculitis, but her cerebral spinal fluid parameters were benign and initial cultures were negative. Consequently, treatment was tailored to an assumed respiratory infection only to have recurrence of her symptoms. Repeat analysis of her cerebral spinal fluid was again benign, but her cerebral spinal fluid culture grew S. paucimobilis. Subsequently, the patient was treated with cefepime, which resolved her symptoms. She completed a two-week course and has had no recurrence of her infection. Conclusions This case reinforces the need for clinicians to have heightened awareness of this emerging pathogen, its antibiotic resistance patterns, and the unique composition of this bacterium's cell wall which has ramifications on disease presentation.
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Affiliation(s)
- James B. Doub
- MD, Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, 725 west Lombard Street, Baltimore, Maryland, 21201, USA
| | - Joel V. Chua
- MD, Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, 725 west Lombard Street, Baltimore, Maryland, 21201, USA
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12
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Haldrup M, Miscov R, Mohamad N, Rasmussen M, Dyrskog S, Simonsen CZ, Grønhøj M, Poulsen FR, Bjarkam CR, Debrabant B, Korshøj AR. Treatment of Intraventricular Hemorrhage with External Ventricular Drainage and Fibrinolysis: A Comprehensive Systematic Review and Meta-Analysis of Complications and Outcome. World Neurosurg 2023; 174:183-196.e6. [PMID: 36642373 DOI: 10.1016/j.wneu.2023.01.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 01/13/2023]
Abstract
BACKGROUND External ventricular drainage (EVD) is a key factor in the treatment of intraventricular hemorrhage (IVH) but associated with risks and complications. Intraventricular fibrinolysis (IVF) has been proposed to improve clinical outcome and reduce complications of EVD treatment. The following review and metaanalysis provides a comprehensive evaluation of IVH treatment with external ventricular drainage (EVD) and intraventricular fibrinolysis (IVF) with regards to complications and clinical outcomes. METHODS The PRISMA guidelines were followed preparing this review. Studies included in the meta-analysis were compared using forest plots and the related odds ratios. RESULTS After a literature search, 980 articles were identified and 65 and underwent full-text review. Forty-two articles were included in the review and meta-analysis. We found that bolted and antibiotic-coated catheters were superior to tunnelled/uncoated catheters (P < 0.001) and antibiotic- vs. silver-impregnated catheters (P < 0.001]) in preventing infection. Shunt dependency was related to the volume of blood in the ventricles but unaffected by IVF (P = 0.98). IVF promoted hematoma clearance, decreased mortality (22.4% vs. 40.9% with IVF vs. no IVF, respectively, P < 0.00001), improved good functional outcomes (47.2% [IVF] vs. 38.3% [no IVF], P = 0.03), and reduced the rate of catheter occlusion from 37.3% without IVF to 10.6% with IVF (P = 0.0003). CONCLUSIONS We present evidence and best practice recommendations for the treatment of IVH with EVD and intraventricular fibrinolysis. Our analysis further provides a comprehensive quantitative reference of the most relevant clinical endpoints for future studies on novel IVH technologies and treatments.
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Affiliation(s)
- Mette Haldrup
- Department of Neurosurgery, Aarhus University Hospital, Aarhus N, Denmark.
| | - Rares Miscov
- Department of Neurosurgery, Aalborg University Hospital, Aalborg, Denmark
| | - Niwar Mohamad
- Department of Anesthesiology, Section of Neuroanesthesia, Aarhus University Hospital, Aarhus, Denmark
| | - Mads Rasmussen
- Department of Anesthesiology, Section of Neuroanesthesia, Aarhus University Hospital, Aarhus, Denmark
| | - Stig Dyrskog
- Department of Intensive Care, Aarhus University Hospital, Aarhus N, Denmark
| | - Claus Ziegler Simonsen
- Department of Neurology, Aarhus University Hospital, Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Mads Grønhøj
- Department of Neurosurgery, Odense University Hospital, Odense, Denmark
| | | | | | - Birgit Debrabant
- Department of Mathematics and Computer Science, Data Science and Statistics, University of Southern Denmark, Odense M, Denmark
| | - Anders Rosendal Korshøj
- Department of Neurosurgery, Aarhus University Hospital, Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
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13
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Doub JB. A pilot study for evaluating the feasibility of using Alpha Defensin to support the diagnosis of ventriculitis. Int J Infect Dis 2023; 132:80-83. [PMID: 37059298 DOI: 10.1016/j.ijid.2023.04.389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/06/2023] [Accepted: 04/08/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Nosocomial ventriculitis is a difficult infectious condition to diagnose given typical CSF parameters, commonly used in the diagnosis of meningitis, lack sensitivity and specificity in nosocomial ventriculitis. Consequently, novel diagnostics are needed to aid in diagnosing this condition. Herein a pilot study using alpha defensins to diagnose ventriculitis is discussed. METHODS From 5/1/2022 through 12/30/2022, ten patients with culture proven EVD associated ventriculitis and ten patients without EVD associated ventriculitis had cerebral spinal fluid preserved. Levels of α-defensins were compared between the two cohorts with enzyme linked immunosorbent assay. RESULTS There was a statistically significant (P ˂ 0.0001) higher level of cerebral spinal fluid α-defensins in the ventriculitis cohort compared to the non-ventriculitis cohort. The levels of α-defensins were not affected by blood in cerebral spinal fluid or bacterial virulence. Patients with other infectious conditions had increased levels of α-defensins but these levels were still statistically significantly (P ˂ 0.001) less than those seen in the ventriculitis cohort. CONCLUSION This pilot study shows that α-defensins has promise as a biomarker to aid in the diagnosis of ventriculitis. If larger studies support the findings here, this biomarker can help improve diagnostic accuracy and decrease unwarranted empirical broad spectrum antibiotic use in suspected EVD-associated ventriculitis.
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Affiliation(s)
- James B Doub
- The Doub Laboratory of Translational Bacterial Research, University of Maryland School of Medicine, Baltimore, Maryland, USA; Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
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14
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Theofanopoulos A, Fermeli D, Vekios D, Bizos A, Marangos M, Constantoyannis C, Panagiotopoulos V, Assimakopoulos SF. Successful treatment of pan-drug resistant Acinetobacter baumannii nosocomial meningitis/ ventriculitis by combined intravenous and intrathecal colistin-tigecycline administration: a case series. Infez Med 2023; 31:103-107. [PMID: 36908383 PMCID: PMC9994833 DOI: 10.53854/liim-3101-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND This study aims to evaluate the efficacy of combined intraventricular and intravenous co-administration of colistin and tigecycline in the management of pan-drug resistant Acinetobacter baumannii meningitis/ventriculitis. METHODS In this case series we report 3 patients with healthcare-associated ventriculitis/meningitis caused by pan-drug resistant Acinetobacter baumannii that were treated with combined colistin and tigecycline administration through both intraventricular and intravenous routes. RESULTS All patients were administered colistin intraventricularly at a dose of 250.000 IU q.d. and intravenously at 9 million IU loading dose, followed after 12 hours by maintenance dose of 4.5 million IU every 12 hours and tigecycline intraventricularly at a dose of 10 mg b.i.d. and intravenously at 200 mg loading dose followed after 12 hours by 100 mg every 12 hours. In patients with a calculated creatinine clearance of less than 60 ml/min, according to the Cockcroft-Gault formula, the maintenance dose of colistin was reduced based on a modified formula. All patients had a favourable clinical and microbiological response with evidence of CSF sterilization. CONCLUSIONS Taking advantage of the synergistic action of combined colistin and tigecycline through administration both intraventricularly and intravenously may be a promising salvage option for critically ill patients with pan-drug resistant A. baumannii CNS infection.
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Affiliation(s)
| | - Dionysia Fermeli
- University Hospital of Patras, Department of Neurosurgery, Patras,
Greece
| | - Dionysios Vekios
- University Hospital of Patras, Department of Internal Medicine, Division of Infectious Diseases, Patras,
Greece
| | - Aristeidis Bizos
- University Hospital of Patras, Department of Internal Medicine, Division of Infectious Diseases, Patras,
Greece
| | - Markos Marangos
- University Hospital of Patras, Department of Internal Medicine, Division of Infectious Diseases, Patras,
Greece
| | | | | | - Stelios F. Assimakopoulos
- University Hospital of Patras, Department of Internal Medicine, Division of Infectious Diseases, Patras,
Greece
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15
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Zeggay A, Patry I, Chirouze C, Bouiller K. Characteristics and outcomes of cerebrospinal fluid shunt and drain-associated infections. Infect Dis Now 2023; 53:104665. [PMID: 36736666 DOI: 10.1016/j.idnow.2023.104665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/11/2023] [Accepted: 01/24/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Data on infections associated with cerebrospinal fluid shunt (CSF-S) or device-associated infection (CSF-SDI) are limited in adults. We performed a retrospective study to describe characteristics, management, and outcome of CSF-SDI. METHODS All patients with CSF-SDI and admitted to our institution from January 2013 to December 2019 were included. RESULTS Among 50 patients, fifty-six episodes of CSF-SDI (41 external ventricular device-associated infections (CSF-D) and 15 other shunt infections (CSF-S) were included. The incidence of CSF-SDI was 11.9 %. Fever was the most common symptom (81 %). Enterobacterales were more prevalent in CSF-S than in CSF-D (20 % vs 53 %, p = 0.02). As regards CSF-D, deceased patients (11/41, 27 %) more frequently had a Glasgow coma scale score decreasing from baseline (p < 0.01), lower glycorrhachia (p < 0.01), a higher protein level in CSF (p = 0.001) and a positive control CSF culture (p = 0.031). CONCLUSIONS CSF-SDIs are rare but with a high mortality rate. Mortality was more closely related to the infection than to comorbidities or underlying neurosurgical disease. A second CSF analysis significantly helped to detect patients with CSF-D with a poor prognosis.
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Affiliation(s)
- Abdeljalil Zeggay
- Department of infectious and tropical diseases, CHRU Besançon, Besançon, France.
| | - Isabelle Patry
- Laboratory of microbiology, CHRU Besançon, Besançon, France
| | - Catherine Chirouze
- Department of infectious and tropical diseases, CHRU Besançon, Besançon, France; UMR CNRS 6249 Chrono-Environnement, University of Bourgogne Franche-Comté, Besançon, France
| | - Kevin Bouiller
- Department of infectious and tropical diseases, CHRU Besançon, Besançon, France; UMR CNRS 6249 Chrono-Environnement, University of Bourgogne Franche-Comté, Besançon, France
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16
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Duong MT, Rudie JD, Mohan S. Neuroimaging Patterns of Intracranial Infections: Meningitis, Cerebritis, and Their Complications. Neuroimaging Clin N Am 2023; 33:11-41. [PMID: 36404039 PMCID: PMC10904173 DOI: 10.1016/j.nic.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Neuroimaging provides rapid, noninvasive visualization of central nervous system infections for optimal diagnosis and management. Generalizable and characteristic imaging patterns help radiologists distinguish different types of intracranial infections including meningitis and cerebritis from a variety of bacterial, viral, fungal, and/or parasitic causes. Here, we describe key radiologic patterns of meningeal enhancement and diffusion restriction through profiles of meningitis, cerebritis, abscess, and ventriculitis. We discuss various imaging modalities and recent diagnostic advances such as deep learning through a survey of intracranial pathogens and their radiographic findings. Moreover, we explore critical complications and differential diagnoses of intracranial infections.
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Affiliation(s)
- Michael Tran Duong
- Division of Neuroradiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Jeffrey D Rudie
- Department of Radiology, Scripps Clinic and University of California San Diego, 10666 Torrey Pines Road, La Jolla, CA 92037, USA
| | - Suyash Mohan
- Division of Neuroradiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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17
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Boethun A, Vissing NH, Mathiasen R, Skjøth-Rasmussen J, Foss-Skiftesvik J. CNS infection in children with brain tumors: adding ventriculostomy to brain tumor resection increases risk more than 20-fold. Childs Nerv Syst 2023; 39:387-394. [PMID: 36536059 DOI: 10.1007/s00381-022-05799-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To investigate the risk of central nervous system (CNS) infections in children undergoing neurosurgery for brain tumors. METHODS Single-center retrospective cohort study including all children with brain tumors undergoing neurosurgical treatment over an 11-year period. RESULTS A total of 274 patients undergoing 733 neurosurgical procedures were included. Overall, 12.8% of patients were diagnosed with a CNS infection during their course of treatment. CNS infections were more frequent among children treated with CSF diversion (p < 0.001) and independently associated with low age (OR/y 0.9 (CI 95% 0.769-0.941), intraventricular (OR 2.8, CI 95% 1.2-6.5), and high-grade tumors (OR 2.7, CI 95% 1.1-6.5). The majority of CNS infections occurred within 30 days of surgery, resulting in a postoperative CNS infection rate of 5.3%. Postoperative CNS infections were significantly more frequent following adjunct EVD placement during tumor resection compared to a stand-alone craniotomy (30.4% vs. 1.5%, RR 20.6, CI 95% 5.7-72.2). CONCLUSION CNS infections affect at least 12% of children with brain tumors and are associated with age, tumor location, and grade. Adding EVD to tumor surgery increases the risk of postoperative CNS infection, and reconsidering routine adjunct EVD placement is therefore advocated.
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Affiliation(s)
- Anna Boethun
- Department of Neurosurgery, University Hospital Rigshospitalet, 2100, Copenhagen, Denmark. .,Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, 2100, Copenhagen, Denmark.
| | - Nadja Hawwa Vissing
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, 2100, Copenhagen, Denmark
| | - René Mathiasen
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, 2100, Copenhagen, Denmark
| | - Jane Skjøth-Rasmussen
- Department of Neurosurgery, University Hospital Rigshospitalet, 2100, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jon Foss-Skiftesvik
- Department of Neurosurgery, University Hospital Rigshospitalet, 2100, Copenhagen, Denmark. .,Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, 2100, Copenhagen, Denmark.
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18
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Hoefnagel D, Volovici V, Dos Santos Rubio EJ, Voor In't Holt AF, Dirven CMF, Vos MC, Dammers R. Impact of an external ventricular shunt (EVD) handling protocol on secondary meningitis rates: a historical cohort study with propensity score matching. BMC Neurol 2023; 23:36. [PMID: 36690947 PMCID: PMC9869497 DOI: 10.1186/s12883-023-03080-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 01/11/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND External ventricular drainage (EVD) is frequently used in neurosurgical procedures for cerebrospinal fluid (CSF) drainage. It is, however, associated with high infection rates, namely secondary meningitis and ventriculitis. Based on a previous high prevalence of these infections among patients with EVDs, we have proposed and implemented a protocol in an effort to decrease the infection rate. The aim of this study was to measure the effect of hospital-wide implementation of the EVD handling protocol on secondary EVD infections. PATIENTS AND METHODS We included 409 consecutive patients who received a new EVD for other indications than infectious pathologies from January 2000 until June 2012. Patients above 18 years of age were divided into pre- (n = 228) and post-protocol (n = 181) groups. Patient and disease demographics, as well as EVD data together with confounders for secondary meningitis were recorded in a database. Propensity score matching was then performed to create groups matched for sex, age, reason for drainage, type of shunt, time in situ and duration of surgery to place the EVD. Binomial logistic regression for confounder adjustment and regression discontinuity analyses were then performed on the matched cohort. RESULTS Infections occurred more frequently in the pre-protocol group (23% vs 9%, p < 0.001). The incidence of infection was 33/1000 drain-days pre-protocol and 9/1000 drain-days post-protocol. Regression analysis in a propensity score-matched cohort (n = 103 in the pre- and n = 178 in the post-protocol groups) showed that the pre-protocol period was independently associated with more infections (OR 2.69; 95%-CI 1.22-5.95, p = 0.01). CONCLUSIONS The incidence of secondary EVD infections can be reduced significantly by the implementation of a strict hospital-wide EVD handling protocol.
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Affiliation(s)
- Daphna Hoefnagel
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Center, Doctor Molewaterplein 40 Room-#: Na-2112, 3015 GD, Rotterdam, the Netherlands
| | - Victor Volovici
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Center, Doctor Molewaterplein 40 Room-#: Na-2112, 3015 GD, Rotterdam, the Netherlands.
- Department of Public Health, Center for Medical Decision Making, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
| | | | - Anne F Voor In't Holt
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Clemens M F Dirven
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Center, Doctor Molewaterplein 40 Room-#: Na-2112, 3015 GD, Rotterdam, the Netherlands
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Ruben Dammers
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Center, Doctor Molewaterplein 40 Room-#: Na-2112, 3015 GD, Rotterdam, the Netherlands
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19
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Haq SH, Shah SR, Bux J, Le AS, Golzarian H, Mueller D, Sreenan JJ, Patel SM, Laird A, Cole W. To intervene or not to intervene: A case of symptomatic neurocysticercosis complicated by ventriculitis. IDCases 2023; 31:e01702. [PMID: 36747911 PMCID: PMC9898726 DOI: 10.1016/j.idcr.2023.e01702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/19/2023] [Accepted: 01/19/2023] [Indexed: 01/22/2023] Open
Abstract
Although well described in the current literature, Neurocysticercosis [NCC] remains an enigma when confronted by practitioners. This is in part due to the haphazard nature of the parasitic infection on the central nervous system [CNS]. These include single or multiple anatomic sites of infection, stage of parasitosis, and the resultant inflammatory response. As a result, NCC can present with a complex constellation of symptomatic presentations, making therapeutic regiments highly individualized. Despite intervention, other impediments may arise post-therapy due to the nature of the infection. We present a case of rapidly progressive symptomatic NCC that initially was successfully treated, however would eventually succumb to complications of ventriculitis.
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Affiliation(s)
- Syed H. Haq
- Department of Internal Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - Sidra R. Shah
- Department of Internal Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - Jannet Bux
- Department of Internal Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - Anh Si Le
- Department of Internal Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - Hafez Golzarian
- Department of Internal Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - Daniel Mueller
- Department of Internal Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - Joseph J. Sreenan
- Department of Pathology Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - Sandeep M. Patel
- Department of Interventional Cardiology, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - Amanda Laird
- Department of Critical Care Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - William Cole
- Department of Critical Care Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
- Correspondence to: Department of Critical Care, St. Rita's Medical Center (Mercy), 730 West Market Street, Lima, OH 45801, USA.
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20
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Abstract
Ventriculitis is a severe complication of indwelling neurosurgical devices that is associated with significant morbidity and mortality. The incidence rate of ventriculitis is approximately 10% with external ventricular drains. Obstinately, patients with these indwelling neurosurgical devices are prone to have traditional cerebral spinal fluid parameters that lack sensitivity and specificity in diagnosing nosocomial ventriculitis. In addition, diagnosis can be arduous given that indolent pathogens are commonly implicated. Therefore, diagnosis is difficult but paramount to thwart the morbidity and mortality associated with this infectious condition as well as to reduce the prolonged use of broad-spectrum antibiotics. As we extrapolate from prosthetic joint infections, for which diagnosis can also be challenging, we learn that the use of α-defensins as a diagnostic biomarker for nosocomial ventriculitis may hold promise. Herein, the viewpoint of using α-defensins as a diagnostic biomarker for nosocomial ventriculitis is discussed.
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21
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Megjhani M, Terilli K, Kalasapudi L, Chen J, Carlson J, Miller S, Badjatia N, Hu P, Velazquez A, Roh DJ, Agarwal S, Claassen J, Connolly ES, Hu X, Morris N, Park S. Dynamic Intracranial Pressure Waveform Morphology Predicts Ventriculitis. Neurocrit Care 2022; 36:404-411. [PMID: 34331206 PMCID: PMC9847350 DOI: 10.1007/s12028-021-01303-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/14/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Intracranial pressure waveform morphology reflects compliance, which can be decreased by ventriculitis. We investigated whether morphologic analysis of intracranial pressure dynamics predicts the onset of ventriculitis. METHODS Ventriculitis was defined as culture or Gram stain positive cerebrospinal fluid, warranting treatment. We developed a pipeline to automatically isolate segments of intracranial pressure waveforms from extraventricular catheters, extract dominant pulses, and obtain morphologically similar groupings. We used a previously validated clinician-supervised active learning paradigm to identify metaclusters of triphasic, single-peak, or artifactual peaks. Metacluster distributions were concatenated with temperature and routine blood laboratory values to create feature vectors. A L2-regularized logistic regression classifier was trained to distinguish patients with ventriculitis from matched controls, and the discriminative performance using area under receiver operating characteristic curve with bootstrapping cross-validation was reported. RESULTS Fifty-eight patients were included for analysis. Twenty-seven patients with ventriculitis from two centers were identified. Thirty-one patients with catheters but without ventriculitis were selected as matched controls based on age, sex, and primary diagnosis. There were 1590 h of segmented data, including 396,130 dominant pulses in patients with ventriculitis and 557,435 pulses in patients without ventriculitis. There were significant differences in metacluster distribution comparing before culture-positivity versus during culture-positivity (p < 0.001) and after culture-positivity (p < 0.001). The classifier demonstrated good discrimination with median area under receiver operating characteristic 0.70 (interquartile range 0.55-0.80). There were 1.5 true alerts (ventriculitis detected) for every false alert. CONCLUSIONS Intracranial pressure waveform morphology analysis can classify ventriculitis without cerebrospinal fluid sampling.
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Affiliation(s)
- Murad Megjhani
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States of America,Program for Hospital and Intensive Care Informatics, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States of America
| | - Kalijah Terilli
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States of America,Program for Hospital and Intensive Care Informatics, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States of America
| | - Lakshman Kalasapudi
- Department of Neurology, Program in Trauma, University of Maryland School of Medicine
| | - Justine Chen
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States of America,New York Presbyterian Hospital – Columbia University Irving Medical Center, New York, New York, United States of America
| | - John Carlson
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States of America,Program for Hospital and Intensive Care Informatics, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States of America
| | - Serenity Miller
- Department of Anesthesia, Program in Trauma, University of Maryland School of Medicine
| | - Neeraj Badjatia
- Department of Neurology, Program in Trauma, University of Maryland School of Medicine
| | - Peter Hu
- Department of Anesthesia, Program in Trauma, University of Maryland School of Medicine
| | - Angela Velazquez
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States of America
| | - David J. Roh
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States of America,New York Presbyterian Hospital – Columbia University Irving Medical Center, New York, New York, United States of America
| | - Sachin Agarwal
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States of America,New York Presbyterian Hospital – Columbia University Irving Medical Center, New York, New York, United States of America
| | - Jan Claassen
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States of America,New York Presbyterian Hospital – Columbia University Irving Medical Center, New York, New York, United States of America
| | - ES. Connolly
- New York Presbyterian Hospital – Columbia University Irving Medical Center, New York, New York, United States of America,Department of Neurosurgery, Columbia University, New York, New York, United States of America
| | - Xiao Hu
- School of Nursing, Duke University, Durham, North Carolina, United States of America,Departments of Electrical and Computer Engineering, Biostatistics and Bioinformatics, Surgery, Neurology, Duke University, Durham, North Carolina, United States of America
| | - Nicholas Morris
- Department of Neurology, Program in Trauma, University of Maryland School of Medicine
| | - Soojin Park
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States of America,Program for Hospital and Intensive Care Informatics, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States of America,New York Presbyterian Hospital – Columbia University Irving Medical Center, New York, New York, United States of America
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22
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König C, Grensemann J, Czorlich P, Schlemm E, Kluge S, Wicha SG. A dosing nomograph for cerebrospinal fluid penetration of meropenem applied by continuous infusion in patients with nosocomial ventriculitis. Clin Microbiol Infect 2022; 28:1022.e9-1022.e16. [PMID: 35182756 DOI: 10.1016/j.cmi.2022.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 12/11/2022]
Abstract
OBJECTIVES In difficult to treat infections such as nosocomial ventriculitis, meropenem exposure in the infected compartment is often uncertain but crucial for antibacterial effects. The aim of this study was to investigate the cerebrospinal fluid (CSF) penetration of meropenem in patients with nosocomial ventriculitis and to derive a nomograph to predict effective meropenem doses as a function of clinical parameters. METHODS Retrospective patient data including meropenem serum and CSF levels, as well as CSF inflammation markers were analysed using NONMEM® to assess the general pharmacokinetics and CSF penetration. Monte Carlo simulations (MCS) were used to evaluate different meropenem dosing regimens. Probability of target attainment (PTA) in CSF was assessed and a nomograph to achieve a target concentration of 4 mg/L was developed. RESULTS A one-compartment model with meropenem clearance dependent on the estimated glomerular filtration rate (CKD-EPI eGFR, p< 5 e-10) best described meropenem serum pharmacokinetics of 51 critically ill patients. CSF penetration ratio was correlated with the amount of protein in CSF (p< 1 e-8), with higher CSF protein levels accounting for higher penetration ratios. Preserved renal function (CKD-EPI GFR> 50 ml/min/1.73 m2) as well as low CSF protein levels (<500 mg/L) resulted in 80 % PTA (100 %fT>2xMIC) for a meropenem dose of 6 g/24 h. CONCLUSIONS High interindividual variability in meropenem CSF concentration was observed in patients with nosocomial ventriculitis. A nomograph to predict the daily meropenem dose required for target attainment for a given eGFR and CSF protein count was developed.
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Affiliation(s)
- Christina König
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Germany; Hospital Pharmacy, University Medical Center Hamburg-Eppendorf, Germany.
| | - Jörn Grensemann
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - Patrick Czorlich
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Germany
| | - Eckhard Schlemm
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - Sebastian G Wicha
- Department of Clinical Pharmacy, Institute of Pharmacy, University Hamburg, Germany
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23
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Hess RM, Khan A, Edwards M, Siddiqui AH, Levy EI. Continuous intraventricular vancomycin for treatment of ventriculitis using IRRAflow®: A case report. Surg Neurol Int 2022; 12:583. [PMID: 34992900 PMCID: PMC8720421 DOI: 10.25259/sni_1036_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/01/2021] [Indexed: 11/04/2022] Open
Abstract
Background Ventriculitis usually occurs as the result of infection and results in the inflammation of the ependymal lining of the ventricular system. Mortality rates remain high despite treatment. Case Description We present the case of a 66-year-old man who presented with altered mental status and progressively became comatose. He was found to have fulminant ventriculitis due to a ruptured intracranial abscess. He was treated with bilateral IRRAflow® catheter (IRRAS, Stockholm, Sweden) placement through which continuous irrigation with vancomycin was initiated. Conclusion This treatment was safe and led to improvement in the patient's neurologic examination, imaging findings, and cerebrospinal fluid profiles.
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Affiliation(s)
- Ryan M Hess
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo and Buffalo General Medical Center, Kaleida Health, Buffalo, New York, United States
| | - Asham Khan
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo and Buffalo General Medical Center, Kaleida Health, Buffalo, New York, United States
| | - Mallory Edwards
- Department of Neurocritical Care, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, United States
| | - Adnan H Siddiqui
- Departments of Neurosurgery and Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo and Buffalo General Medical Center, Kaleida Health, Buffalo, New York, United States
| | - Elad I Levy
- Departments of Neurosurgery and Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo and Buffalo General Medical Center, Kaleida Health, Buffalo, New York, United States
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24
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Rathish B, Wilson A, Warrier A, Babu R, Ahammadunny R, Joy S. Nocardia farcinica ventriculitis and meningitis in an immunocompromised man with Crohn's disease. Infect Dis Now 2021; 51:572-574. [PMID: 34486525 DOI: 10.1016/j.idnow.2020.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/06/2020] [Accepted: 11/18/2020] [Indexed: 11/26/2022]
Affiliation(s)
- B Rathish
- Dept of Infectious Diseases, Aster Medcity, Kochi, India
| | - A Wilson
- Dept of Infectious Diseases, Aster Medcity, Kochi, India.
| | - A Warrier
- Dept of Infectious Diseases, Aster Medcity, Kochi, India
| | - R Babu
- Dept of Clinical Microbiology, Aster Medcity, Kochi, India
| | - R Ahammadunny
- Dept of Internal Medicine, Aster Medcity, Kochi, India
| | - S Joy
- Dept of Clinical Microbiology, Aster Medcity, Kochi, India
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25
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Walek KW, Leary OP, Sastry R, Asaad WF, Walsh JM, Mermel L. Decreasing External Ventricular Drain Infection Rates in the Neurocritical Care Unit: 12-Year Longitudinal Experience at a Single Institution. World Neurosurg 2021; 150:e89-e101. [PMID: 33647492 DOI: 10.1016/j.wneu.2021.02.087] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE External ventricular drain (EVD) placement is a common neurosurgical procedure, and EVD-related infection is a significant complication. We examined the effect of infection control protocol changes on EVD-related infection incidence. METHODS Changes in EVD placement protocol and incidence density of infections after implementation of protocol changes in the neurocritical care unit were tracked from 2007 to 2019. EVD infections were defined using a modified U.S. Centers for Disease Control and Prevention National Healthcare Safety Network surveillance definition of meningitis/ventriculitis for patients with EVDs in situ for at least 2 days confirmed by positive culture. Contribution of protocol changes to EVD infection risk was assessed via multivariate regression. RESULTS Fifteen major changes in EVD protocol were associated with a reduction in infections from 6.7 to 2.0 per 1000 EVD days (95% confidence interval [CI], 4.1-5.3; P < 0.001). Gram-positive bacterial infection incidence decreased from 4.8 to 1.7 per 1000 EVD days (95% CI, 2.3-3.9; P = 0.00882) and gram-negative infection incidence decreased from 1.9 to 0.5 per 1000 EVD days (95% CI, 0.6-2.3; P = 0.0303). Of all protocol changes since 2007, the largest reduction in incidence was 3.9 infections per 1000 days (95% CI, 0.50-7.30; P = 0.011), associated with combined standardization of reduced EVD sampling frequency, cutaneous antisepsis with alcoholic chlorhexidine before EVD placement, and use of a subcutaneous tunneling technique during EVD insertion. CONCLUSIONS The most significant reduction in EVD infections may be achieved through the combination of reducing EVD sampling frequency and standardizing alcoholic chlorhexidine cutaneous antisepsis and subcutaneous tunneling of the EVD catheter.
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Affiliation(s)
- Konrad W Walek
- Department of Neurosurgery, Warren Alpert Medical School of Medicine of Brown University, Providence, Rhode Island, USA
| | - Owen P Leary
- Department of Neurosurgery, Warren Alpert Medical School of Medicine of Brown University, Providence, Rhode Island, USA
| | - Rahul Sastry
- Department of Neurosurgery, Warren Alpert Medical School of Medicine of Brown University, Providence, Rhode Island, USA
| | - Wael F Asaad
- Department of Neurosurgery, Warren Alpert Medical School of Medicine of Brown University, Providence, Rhode Island, USA; Department of Neuroscience, Brown University, Providence, Rhode Island, USA; Norman Prince Neuroscience Institute, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Joan M Walsh
- Division of Critical Care, Department of Nursing, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Leonard Mermel
- Department of Medicine, Warren Alpert Medical School of Medicine of Brown University, Providence, Rhode Island, USA; Department of Epidemiology and Infection Control, Rhode Island Hospital, Providence, Rhode Island, USA; Division of Infectious Diseases, Rhode Island Hospital, Providence, Rhode Island, USA.
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26
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Megjhani M, Terilli K, Kaplan A, Wallace BK, Alkhachroum A, Hu X, Park S. Use of Clustering to Investigate Changes in Intracranial Pressure Waveform Morphology in Patients with Ventriculitis. Acta Neurochir Suppl 2021; 131:59-62. [PMID: 33839819 PMCID: PMC9840528 DOI: 10.1007/978-3-030-59436-7_13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE This study aimed to examine whether changes in intracranial pressure (ICP) waveform morphologies can be used as a biomarker for early detection of ventriculitis. METHODS Consecutive patients (N = 1653) were prospectively enrolled in a hemorrhage outcomes study from 2006 to 2018. Of these, 435 patients (26%) required external ventricular drains (EVDs) and 76 (17.5% of those with EVDs) had ventriculitis treated with antibiotics. Nineteen patients (25% of those with ventriculitis) showed culture-positive cerebrospinal fluid (CSF) and were included in the present analysis. CSF was routinely cultured three times per week and additionally if infection was suspected. EVDs were left open for drainage, with ICP assessed hourly by clamping. Using wavelet analysis, we extracted uninterrupted segments of ICP waveforms. We extracted dominant pulses from continuous high-resolution data, using morphological clustering analysis of intracranial pressure (MOCAIP). Then we applied k-means clustering, using the dynamic time warping distance to obtain morphologically similar groupings. Finally, metaclusters and further-split clusters (when equipoise existed) were categorized for broad comparison by clinician consensus. RESULTS We extracted 275,911 dominant pulses from 459.9 h of EVD data. Of these, 112,898 pulses (40.9%) occurred before culture positivity, 41,300 pulses (15.0%) occurred during culture positivity, and 121,713 pulses (44.1%) occurred after it. K-means identified 20 clusters, which were further grouped into metaclusters: tri-/biphasic, single-peak, and artifactual waveforms. Prior to ventriculitis, 61.8% of dominant pulses were tri-/biphasic; this percentage reduced to 22.6% during ventriculitis and 28.4% after it (p < 0.0001). One day before the first positive cultures were collected, the distribution of metaclusters changed to include more single-peak and artifactual ICP waveforms (p < 0.0001). CONCLUSION The distribution of ICP waveform morphology changes significantly prior to clinical diagnosis of ventriculitis and may be a potential biomarker.
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Affiliation(s)
- Murad Megjhani
- Division of Hospitalist and Critical Care Neurology, Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
| | - Kalijah Terilli
- Division of Hospitalist and Critical Care Neurology, Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
| | - Aaron Kaplan
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Brendan K. Wallace
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Ayham Alkhachroum
- Division of Hospitalist and Critical Care Neurology, Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
| | - Xiao Hu
- Division of Physiological Nursing, School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Soojin Park
- Division of Hospitalist and Critical Care Neurology, Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA,Corresponding Author: Soojin Park, 177 Fort Washington Ave, 8 Milstein - 300 Center, New York, NY, USA 10032, , (212) 305-7236
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27
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Noh SM, Kang HG. Bacterial meningitis and ventriculitis following cervical neuroplasty. Int J Infect Dis 2020; 101:393-394. [PMID: 33075537 DOI: 10.1016/j.ijid.2020.10.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/06/2020] [Accepted: 10/09/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- Sang-Mi Noh
- Department of Neurology, St. Vincent's Hospital, School of Medicine, The Catholic University of Korea, Suwon, South Korea
| | - Hyun Goo Kang
- Department of Neurology, Jeonbuk National University Medical School, Jeonju, South Korea.
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28
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Abdallah M, Alsaleh H, Baradwan A, Alfawares R, Alobaid A, Rasheed A, Soliman I. Intraventricular Tigecycline as a Last Resort Therapy in a Patient with Difficult-to-Treat Healthcare-Associated Acinetobacter baumannii Ventriculitis: a Case Report. ACTA ACUST UNITED AC 2020; 2:1683-1687. [PMID: 32838183 PMCID: PMC7415013 DOI: 10.1007/s42399-020-00433-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2020] [Indexed: 12/21/2022]
Abstract
Healthcare-associated ventriculitis and meningitis is a common complication in patients who suffer from head trauma or have undergone a neurosurgery. Healthcare-associated ventriculitis and meningitis is associated with significant morbidity and mortality. Complications of healthcare-associated ventriculitis and meningitis include persistent vegetative state, moderate and severe disability, and death. Acinetobacter baumannii is the causative pathogen in 3.6–11.2% of cases of healthcare-associated ventriculitis and meningitis. Cases of difficult-to-treat healthcare-associated A. baumannii ventriculitis and meningitis are being reported more frequently. However, in most of these cases, a combination of intravenous (IV) and intraventricular (IVT)/intrathecal colistin achieves good therapeutic outcome. This report describes a clinical case of difficult-to-treat healthcare-associated A. baumannii ventriculitis. The A. baumannii strain was sensitive to colistin and trimethoprim-sulfamethoxazole, intermediate to tigecycline, and resistant to other antibiotics. While colistin was the drug of choice in our case, the patient developed anaphylactoid reaction during the IV administration of the loading dose of colistin, which mandated us to discontinue colistin and complicated the treatment of our patient. The patient did not respond to a combination of IV antibiotics that included meropenem, trimethoprim-sulfamethoxazole, and tigecycline. However, when IVT tigecycline was added as a last-resort therapeutic option, the patient’s ventriculitis dramatically improved, and the patient was discharged from the hospital. Physicians who treat patients with healthcare-associated A. baumannii ventriculitis might resort to IVT tigecycline when they run out of therapeutic options.
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Affiliation(s)
- Mohammad Abdallah
- Pharmaceutical Care Services, King Saud Medical City, Riyadh, Saudi Arabia
| | - Hamzeh Alsaleh
- Pharmacy Department, Hamad Medical Corporation, Doha, Qatar
| | - Abdallah Baradwan
- The Division of Infectious Diseases, King Saud Medical City, Riyadh, Saudi Arabia
| | | | - Abdulaziz Alobaid
- Pharmaceutical Care Services, King Saud Medical City, Riyadh, Saudi Arabia
| | - Akram Rasheed
- Department of Nursing Education and Development, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ibrahim Soliman
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
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29
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Rotter J, Graffeo CS, Perry A, Gilder HE, Wilson JW, Link MJ. Polymicrobial Intracerebral Abscess Growing Mycobacterium avium Complex and Achromobacter xylosoxidans: Case Report and Literature Review. World Neurosurg 2020; 141:441-447.e1. [PMID: 32525087 DOI: 10.1016/j.wneu.2020.05.283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/28/2020] [Accepted: 05/30/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Mycobacterium avium complex (MAC) and Achromobacter xylosoxidans (AX) are uncommon sources of neurosurgical infections, particularly in immunocompetent hosts. We report the first published case of intracranial AX abscess and polymicrobial AX-MAC abscess, as well as the fourth MAC abscess in a non-immunocompromised patient. METHODS This case report was conducted via retrospective chart review. A literature review was completed in compliance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. RESULTS Ten years following mucocele resection, a 60-year-old man presented with sinus congestion and headache. Head imaging revealed a left frontal lesion abutting the cribriform plate and ethmoid roof. The patient had a left frontal craniotomy for abscess drainage. Intraoperative cultures demonstrated polymicrobial growth of AX and MAC, managed with antimicrobial therapy and staged skull base reconstruction. Three cases of MAC abscess and 16 cases of AX ventriculitis or meningitis have been reported in immunocompetent patients. All MAC cerebral abscesses occurred in adults, one of whom succumbed to the infection. Of the 9 AX meningitis cases, 4 occurred in neonates and 2 in pediatric patients. Six of the 7 AX ventriculitis cases occurred after neurosurgical operations at the same hospital from contaminated chlorhexidine basins. Except for the neonates, AX ventriculitis or meningitis patients had undergone neurosurgery or had a history of cranial trauma. There were no reports of polymicrobial AX-MAC intracranial abscess. CONCLUSIONS AX and MAC are rare causes of intracranial infection. Patients with these pathogens identified in the central nervous system require a multidisciplinary approach for successful management.
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Affiliation(s)
- Juliana Rotter
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Avital Perry
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Hannah E Gilder
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - John W Wilson
- Division of Infectious Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Link
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA.
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30
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Piva S, Di Paolo A, Galeotti L, Ceccherini F, Cordoni F, Signorini L, Togni T, De Nicolò A, Rasulo FA, Fagoni N, Latronico N, D'Avolio A. Daptomycin Plasma and CSF Levels in Patients with Healthcare-Associated Meningitis. Neurocrit Care 2020; 31:116-124. [PMID: 30607829 DOI: 10.1007/s12028-018-0657-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND There are currently few data concerning the cerebrospinal fluid (CSF) penetration of daptomycin in patients with healthcare-associated meningitis. This study aims (1) to better characterize the pharmacokinetics of daptomycin in humans during a 7-day intravenous (IV) therapy course, and (2) to study the penetration of daptomycin in the CSF after IV infusion at the dose of 10 mg/kg. RESULTS In this prospective observational study, we enrolled nine patients with an implanted external ventricular drainage and a diagnosis of a healthcare-associated meningitis. Daptomycin was administered at 10 mg/kg for a maximum of 7 days. The pharmacokinetic of daptomycin was studied using a two-compartment population/pharmacokinetic (POP/PK) model and by means of a nonlinear mixed effects modeling approach. A large inter-individual variability in plasma area under the curve (Range: 574.7-1366.3 h mg/L), paralleled by high-peak plasma concentration (Cmax) (all values > 60 mg/L), was noted. The inter-individual variability of CSF-AUC although significant (range: 1.17-6.81 h mg/L) was narrower than previously reported and with a late occurrence of CSF-Cmax (range: 6.04-9.54 h). The terminal half-life between plasma and CSF was similar. tmax values in CSF did not show a high inter-individual variability, and the fluctuations of predicted CSF concentrations were minimal. The mean value for daptomycin penetration obtained from our model was 0.45%. CONCLUSIONS Our POP/PK model was able to describe the pharmacokinetics of daptomycin in both plasma and CSF, showing that daptomycin (up to 7 days at 10 mg/kg) has minimal penetration into central nervous system. Furthermore, the observed variability of AUC, tmax and predicted concentration in CSF was lower than what previously reported in the literature. Based on the present findings, it is unlikely that daptomycin could reach CSF concentrations high enough to have clinical efficacy; this should be tested in future studies.
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Affiliation(s)
- S Piva
- Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Piazzale Spedali Civili di Brescia 1, Brescia, Italy. .,Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazza del Mercato, 15, Brescia, Italy.
| | - Antonello Di Paolo
- Department of Clinical and Experimental Medicine, Section of Pharmacology, University of Pisa, Via Roma, 67, Pisa, Italy
| | - Laura Galeotti
- Phymtech Srl (Physical and Mathematical Technologies), Via Giuntini 63, Navacchio di Cascina, Pisa, Italy
| | - Francesco Ceccherini
- Phymtech Srl (Physical and Mathematical Technologies), Via Giuntini 63, Navacchio di Cascina, Pisa, Italy
| | - Francesco Cordoni
- Phymtech Srl (Physical and Mathematical Technologies), Via Giuntini 63, Navacchio di Cascina, Pisa, Italy
| | - Liana Signorini
- Second Division of Clinical Infectious Diseases, Department of Infectious Diseases, Spedali Civili University Hospital, Piazzale Spedali Civili di Brescia, Brescia, Italy
| | - Tommaso Togni
- Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Piazzale Spedali Civili di Brescia 1, Brescia, Italy
| | - Amedeo De Nicolò
- Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - Frank A Rasulo
- Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Piazzale Spedali Civili di Brescia 1, Brescia, Italy.,Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazza del Mercato, 15, Brescia, Italy
| | - Nazzareno Fagoni
- Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Piazzale Spedali Civili di Brescia 1, Brescia, Italy
| | - N Latronico
- Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Piazzale Spedali Civili di Brescia 1, Brescia, Italy.,Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazza del Mercato, 15, Brescia, Italy
| | - Antonio D'Avolio
- Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin, Turin, Italy
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Beier AD, Nikas DC, Assassi N, Bauer DF, Blount JP, Durham SR, Flannery AM, Klimo P, McClung-Smith C, Rehring P, Tamber MS, Tyagi R, Mazzola CA. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on Closure of Myelomeningocele Within 48 Hours to Decrease Infection Risk. Neurosurgery 2020; 85:E412-E413. [PMID: 31418041 DOI: 10.1093/neuros/nyz264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/11/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Appropriate timing for closure of myelomeningocele (MM) varies in the literature. Older studies present 48 h as the timeframe after which infection complication rates rise. OBJECTIVE The objective of this guideline is to determine if closing the MM within 48 h decreases the risk of wound infection or ventriculitis. METHODS The Guidelines Task Force developed search terms and strategies used to search PubMed and Embase for relevant literature published between 1966 and September 2016. Strict inclusion/exclusion criteria were used to screen abstracts and to develop a list of relevant articles for full-text review. Full text articles were then reviewed and when appropriate, included in the evidentiary table. The class of evidence was evaluated, discussed, and assigned to each study that met inclusion criteria. RESULTS A total of 148 abstracts were identified and reviewed. A total of 31 articles were selected for full text analysis. Only 4 of these studies met inclusion criteria. CONCLUSION There is insufficient evidence that operating within 48 h decreases risk of wound infection or ventriculitis in 1 Class III study. There is 1 Class III study that provides evidence of global increase in postoperative infection after 48 h, but is not specific to wound infection or ventriculitis. There is 1 Class III study that provides evidence if surgery is going to be delayed greater than 48 h, antibiotics should be given.The full guideline can be found at https://www.cns.org/guidelines/guidelines-spina-bifida-chapter-4.
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Affiliation(s)
- Alexandra D Beier
- Division of Pediatric Neurosurgery, University of Florida Health Jacksonville, Jacksonville, Florida
| | - Dimitrios C Nikas
- Division of Pediatric Neurosurgery, Advocate Children's Hospital, Oak Lawn, Illinois
| | - Nadege Assassi
- Department of Surgery, Division of Neurosurgery, Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - David F Bauer
- Department of Surgery, Division of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Jeffrey P Blount
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham; Children's of Alabama, Birmingham, Alabama
| | - Susan R Durham
- The University of Vermont Medical Center, Burlington, Vermont
| | - Ann Marie Flannery
- Kids Specialty Center, Women's & Children's Hospital, Lafayette, Louisiana
| | - Paul Klimo
- Semmes-Murphey, Memphis, Tennessee.,Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.,Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Catherine McClung-Smith
- Department of Neurological Surgery, Palmetto Health USC Medical Group, Columbia, South Carolina
| | | | - Mandeep S Tamber
- Division of Pediatric Neurosurgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, Canada
| | - Rachana Tyagi
- Department of Neurosurgery, Mercer University Medical School, Macon, Georgia
| | - Catherine A Mazzola
- Goryeb Children's Hospital, Morristown, NJ; Rutgers Department of Neurological Surgery, Newark, New Jersey
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Qin G, Liang Y, Xu K, Xu P, Ye J, Tang X, Lan S. Neuroendoscopic lavage for ventriculitis: Case report and literature review. Neurochirurgie 2020; 66:127-132. [PMID: 32087178 DOI: 10.1016/j.neuchi.2019.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 12/03/2019] [Accepted: 12/15/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Ventriculitis, one of the difficulties in neurosurgical treatment, is a significant cause of death and morbidity in patients with hydrocephalus. Neuroendoscopy is widely used in the treatment of non-communicable hydrocephalus. The advantages of neuroendoscopy may play a decisive role in the treatment of ventriculitis. CASE REPORT AND METHODS We report a 34-year-old male patient with refractory fever and rapid progressive disturbance of consciousness due to ventriculitis caused by intraventricle rupture in a left colliculus abscess. He received intravenous (IV) antibiotics and saline neuroendoscopic lavage (NEL) combined with septostomy and endoscopic third ventriculostomy leading to rapid recovery and remission of symptoms. We also reviewed the use of NEL for ventriculitis in PubMed from 1970 to January 20, 2019. RESULTS In our review, 93 cases (including the present report) were treated with NEL; 91 cases of infection subsided, and 7 patients died. CONCLUSION NEL may be an effective method for the treatment of ventriculitis.
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Affiliation(s)
- G Qin
- Department of Neurosurgery, People's Hospital of Guangxi Zhuang Autonomous Region, 06 Taoyuan Road, 530021 Nanning, China.
| | - Y Liang
- Department of Neurosurgery, People's Hospital of Guangxi Zhuang Autonomous Region, 06 Taoyuan Road, 530021 Nanning, China.
| | - K Xu
- Department of Neurosurgery, People's Hospital of Guangxi Zhuang Autonomous Region, 06 Taoyuan Road, 530021 Nanning, China.
| | - P Xu
- Department of Neurosurgery, People's Hospital of Guangxi Zhuang Autonomous Region, 06 Taoyuan Road, 530021 Nanning, China.
| | - J Ye
- Department of Neurosurgery, People's Hospital of Guangxi Zhuang Autonomous Region, 06 Taoyuan Road, 530021 Nanning, China.
| | - X Tang
- Department of Neurosurgery, People's Hospital of Guangxi Zhuang Autonomous Region, 06 Taoyuan Road, 530021 Nanning, China.
| | - S Lan
- Department of Neurosurgery, People's Hospital of Guangxi Zhuang Autonomous Region, 06 Taoyuan Road, 530021 Nanning, China.
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López-Amor L, García-Prieto E, Fernández-Suárez J, Escudero D, Vázquez F, Fernández J. Evaluation of a commercial multiplex PCR for diagnosis of central nervous system (CNS) nosocomial infections. J Microbiol Methods 2020; 171:105865. [PMID: 32057898 DOI: 10.1016/j.mimet.2020.105865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/09/2020] [Accepted: 02/09/2020] [Indexed: 11/22/2022]
Abstract
Nosocomial Central Nervous System (CNS) infections are often serious complications of neurosurgical procedures. Their diagnosis is complex and frequently based on microbiological culture. The aim of this work was to evaluate the effectiveness of the FilmArray® Blood Culture Identification (BCID) panel, a multiplex PCR designed to identify the most common etiologic agents of sepsis involved with nosocomial CNS infections. A total of ninety samples were analyzed with the BCID panel. The sensitivity and specificity achieved were 77.4% and 100% respectively, when compared with the reference method (culture). Based on the analysis of the melting curves, another cut-off was established improving sensitivity to 83.9% whilst maintaining 98.3% specificity. The BCID panel seems to be a helpful tool for the prompt diagnosis of CNS nosocomial infections. The cut-off proposed here can increase sensitivity, but further studies are required to confirm its effectiveness and its applicability in clinical microbiology laboratories.
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Saje A, Velnar T, Smrke B, Spazzapan P, Keše D, Kobal B, Beović B. Ureaplasma parvum ventriculitis related to surgery and ventricular peritoneal drainage. J Infect Chemother 2020; 26:513-515. [PMID: 32007385 DOI: 10.1016/j.jiac.2019.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 12/17/2019] [Accepted: 12/20/2019] [Indexed: 11/29/2022]
Abstract
Ureaplasma spp. usually causes genitourinary infections; few reports in the literature describe extragenital infections, usually in immunocompromised patients. We present a case of Ureaplasma parvum ventriculitis in an immunocompetent patient related to ventriculoperitoneal drainage and surgery. Ureaplasma parvum was detected with broad range 16S rRNA PCR and cultured on A8 agar.
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Affiliation(s)
- Andreja Saje
- Department of Infectious Diseases, University Medical Centre Ljubljana, Slovenia.
| | - Tomaž Velnar
- Department of Neurosurgery, University Medical Centre Ljubljana, Slovenia
| | - Barbara Smrke
- Department of Neurosurgery, University Medical Centre Ljubljana, Slovenia
| | - Peter Spazzapan
- Department of Neurosurgery, University Medical Centre Ljubljana, Slovenia
| | - Darja Keše
- Institute of Microbiology and Immunology Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Slovenia
| | - Borut Kobal
- Department of Gynaecology, University Medical Centre Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Slovenia
| | - Bojana Beović
- Department of Infectious Diseases, University Medical Centre Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Slovenia
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Peros T, van Schuppen J, Bohte A, Hodiamont C, Aronica E, de Haan T. Neonatal bacterial meningitis versus ventriculitis: a cohort-based overview of clinical characteristics, microbiology and imaging. Eur J Pediatr 2020; 179:1969-77. [PMID: 32621136 DOI: 10.1007/s00431-020-03723-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/17/2020] [Accepted: 06/22/2020] [Indexed: 11/06/2022]
Abstract
Central nervous system (CNS) infections are potentially life threatening in neonates and can lead to the ill-defined diagnosis of ventriculitis. With this study we aimed to explore and describe ventriculitis regarding clinical, microbiological and ultrasonographic characteristics. We performed a retrospective cohort study including all neonates with a culture-proven CNS infection admitted to our tertiary NICU over a 12-year period (2004-2016). For each case clinical data was gathered, and three timed cranial ultrasounds were anonymized and retrospectively reviewed and assessed for signs of ventriculitis. Forty-five patients were included with 9 (20%) diagnosed with ventriculitis. Mortality in both ventriculitis and non-ventriculitis cases was one-third. Patients with pre-existing conditions as post-haemorrhagic hydrocephalus are at risk of developing ventriculitis. Most common pathogens were gram negative bacteria (68.9%). Ultrasonographic signs of ventriculitis developed over time, and interrater agreement was substantial.Conclusion: Neonatal ventriculitis is a serious entity in the continuum of meningitis. Early and correct diagnoses of ventriculitis are both important because of possible persisting or newly developing hydrocephalus or seizures. Sequential imaging should be performed. What is Known: • CNS infections in neonates lead to high mortality and morbidity. • Ventriculitis is a severe complication of meningitis. What is New: • High morbidity; the majority of ventriculitis patients have pre-existing PHVD and develop seizures and hydrocephalus. • Interrater agreement is good; bedside CUS is a useful tool for reaching a sustainable diagnosis of ventriculitis.
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Brotis AG, Churis I, Karvouniaris M. Local complications of adjunct intrathecal antibiotics for nosocomial meningitis associated with gram-negative pathogens: a meta-analysis. Neurosurg Rev 2019; 44:139-152. [PMID: 31875280 DOI: 10.1007/s10143-019-01226-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 11/21/2019] [Accepted: 12/11/2019] [Indexed: 10/25/2022]
Abstract
Direct delivery of antibiotics to the ventricular system offers an alternative for the management of nosocomial meningitis. However, the available literature frequently results in controversial findings regarding its safety. The present meta-analysis aimed at summarizing the risk of local complications after the administration of intraventricular/intrathecal (IVT/IT) antibiotics for the treatment of ventriculitis/meningitis (VM) associated with gram-negative pathogens. We systematically searched the medical literature from 1964 until July 2018, for clinical studies reporting on complications after the index treatment. The quality of the eligible studies was classified as "high," "moderated," and "low" for randomized controlled trials, observational studies, and case series, respectively. The results were summarized as pooled frequencies, estimated by the random- or fixed-effects models, according to the inter-study heterogeneity. The publication bias was visualized in trim-and-fill funnel plots. Τhe analysis included twenty-three primary studies with 229 patients. The overall complication rate was as high as 0.13 (95% CI 0.08; 0.19, I2 = 9%); chemical meningitis and seizures represented the majority of the complications, with an occurrence rate of 0.11 (95% CI 0.07; 0.17, I2 = 0%) and 0.07 (95% CI 0.04; 0.12; I2 = 0%), respectively. The meta-analysis was based on studies of "moderate" and "low" reporting quality, while the publication bias after inspecting of the funnel plots revealed significant asymmetry. The present review denotes the absence of large, high-quality studies in the field. Nevertheless, IVT/IT was associated with moderate morbidity, mainly attributed to chemical meningitis and seizures. Further high-quality studies are still required before this therapeutic modality becomes broadly established.
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Affiliation(s)
- Alexandros G Brotis
- Department of Neurosurgery, University Hospital of Larissa, Biopolis, Larissa, Greece.
| | - Isaac Churis
- Intensive Care Unit, General Hospital of Giannitsa, Giannitsa, Greece
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Thien A, Soh S, Lock C, Han JX, Chen MW, Srivatsava S, Rao JP, Ang BT, Seow WT, Keong NC. The National Neuroscience Institute External Ventricular Drain Study: A Pragmatic Multisite Risk-Stratification Pathway to Reduce Ventriculostomy-Related Infection. World Neurosurg 2019; 135:e126-e136. [PMID: 31756500 DOI: 10.1016/j.wneu.2019.11.070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 11/11/2019] [Accepted: 11/12/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Ventriculostomy-related infection (VRI) is associated with potential serious morbidity, extended hospitalization duration, increased health care costs, and mortality. We assessed the effectiveness of a pragmatic risk-stratification pathway for external ventricular drain (EVD) management, allowing for surgical decision making, in reducing the rate of VRIs. METHODS Two studies were performed concurrently. A retrospective audit of EVD infection rates and outcomes in our unit across 3 hospitals was conducted from January to December 2014. The second prospective study compared the same variables during the implementation of the EVD pathway across the 3 sites from January 2015 to December 2016. RESULTS The number of patients requiring EVDs increased from 2014 to 2016 (165 vs. 189 vs. 197 patients, respectively), with a significant increase in patients with intraventricular hemorrhage (P = 0.009). Despite increasing risk, overall EVD infections decreased during the implementation period, from 4.8% (8/165) in 2014 to 3.7% in 2015 (7/189) and 2.0% in 2016 (4/197, P = 0.33). In 2 sites (site 1, 2.0% vs. 2.1% vs. 1.9%, and site 2, 4.7% vs. 5.0% vs. 5.3%), transition to the EVD risk-stratification pathway maintained already low infection rates; in site 3, EVD infections decreased from 6.8% (5/73) to 3.9% (4/102) and 0% (0/86, P = 0.06). CONCLUSIONS The introduction of a pragmatic evidence-based risk-stratification pathway, in which different options for EVD management are incorporated, results in low EVD infection rates across a multisite institutional practice. Our results are comparable to published protocols involving the implementation of standard care bundles and/or antibacterial EVDs alone, in reducing VRIs.
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Affiliation(s)
- Ady Thien
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Samantha Soh
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Christine Lock
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Julian Xinguang Han
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Min Wei Chen
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Sunku Srivatsava
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Jai Prashanth Rao
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore; Duke-NUS Medical School, Singapore, Singapore
| | - Beng Ti Ang
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore; Duke-NUS Medical School, Singapore, Singapore
| | - Wan Tew Seow
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore; Duke-NUS Medical School, Singapore, Singapore
| | - Nicole C Keong
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore; Duke-NUS Medical School, Singapore, Singapore.
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Ulloque-Caamaño L, Mo-Carrascal J, Maraby J, Narvaez-Rojas A, Quintana-Pajaro L, Ramos-Villegas Y, Moscote-Salazar LR. Ventriculitis associated with extraventricular drainage: etiology, diagnosis and treatment focused on neurocritic care units. CIR CIR 2019; 87:230-240. [PMID: 30768063 DOI: 10.24875/ciru.18000052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ventriculitis after extraventricular drainage is a very important neurosurgical complication in neurocritical care units. It is necessary to make an early diagnosis, given that the morbidity and mortality secondary to it can be variable, and complicate the evolution of neurocritical patients. Despite this, ventriculostomy continues to be an important pillar in monitoring and treatment. Given the urgency of ventriculitis associated with multiresistant germs, new antimicrobial drugs have emerged as part of the treatment, as intraventricular routes have been proposed within the new investigations. However, the foregoing does not yet have sufficient bases to be able to support it. The present review was carried out with the aim of contributing to an early diagnosis and treatment of ventriculitis associated with extra ventricular drainage in neurocritical patients, and in this way to contribute to improve survival and prevent fatal outcomes in these patients.
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Affiliation(s)
| | - Joulen Mo-Carrascal
- Facultad de Medicina, Universidad de Cartagena, Cartagena de Indias, Colombia
| | - Johana Maraby
- Facultad de Medicina, Universidad de Cartagena, Cartagena de Indias, Colombia
| | - Alexis Narvaez-Rojas
- Cartagena Neurotrauma Research Group, Universidad Nacional Autónoma de Nicaragua, Managua, Nicaragua
| | - Loraine Quintana-Pajaro
- Cartagena Neurotrauma Research Group, Universidad de Cartagena, Cartagena de Indias, Colombia
| | | | - Luis R Moscote-Salazar
- Cartagena Neurotrauma Research Group, Universidad de Cartagena, Cartagena de Indias, Colombia
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Anegbe AO, Shokunbi MT, Oyemolade TA, Badejo OA. Intracranial infection in patients with myelomeningocele: profile and risk factors. Childs Nerv Syst 2019; 35:2205-10. [PMID: 31289854 DOI: 10.1007/s00381-019-04219-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 05/22/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To describe the profile and determine the risk factors for the development of intracranial infections (ICI) in paediatric patients with myelomeningocele (MMC). METHODS Retrospective analysis of data from the records of patients with MMC admitted into our hospital between January 2006 and December 2015. RESULTS We managed a total of 688 paediatric non-trauma neurosurgical patients in our facility during the study period. 29.4% of these patients had MMC. We found the records for 49% of the patients. The male: female ratio was 1.3:1. Most of the MMCs were located in the lumbosacral region (71.7%). The lesion was ruptured in 42.4%, unruptured in 53.5%, and indeterminate in 4.0% of the patients. 48.5% of the MMCs were infected at presentation. Surgical repair of the spinal dysraphism was performed in 74.7% of the patients. Postoperative complications observed in our series include wound dehiscence, cerebrospinal fluid leak, and pseudomeningocele which occurred in 13.5%, 12.2%, and 2.7% of the operated cases of MMC respectively. 28.3% of the patients with MMC developed ICI during the course of hospitalization. 71.4% of patients with MMC-associated ICI had septic neural placode at the initial clinical evaluation. 70% of the patients who had wound dehiscence post-operatively developed ICI. Loculations and abscesses occurred only in patients who had surgical repair. A multivariate logistic regression analysis revealed that septic neural placode, hydrocephalus, a supra-lumbar location of the MMCs and surgical intervention were predictive of ICI (p < 0.05). CONCLUSION Infection of the neural placode, hydrocephalus, locations of the lesions above the lumbar region, and surgical repair were the statistically significant risk factors for ICI in our study population. The trending but statistically insignificant risk factors for ICI in our series may require further assessment with a larger sample size.
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Katzir M, Lefkowitz JJ, Ben-Reuven D, Fuchs SJ, Hussein K, Sviri GE. Decreasing External Ventricular Drain-Related Infection Rates with Duration-Independent, Clinically Indicated Criteria for Drain Revision: A Retrospective Study. World Neurosurg 2019; 131:e474-e481. [PMID: 31382072 DOI: 10.1016/j.wneu.2019.07.205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 07/27/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To lower external ventricular drain (EVD)-related infection rates, in April 2013, our institution enacted a major protocol change, switching from routine EVD replacement every 5 days to EVD replacement only when clinically indicated. In the present study, we evaluated the effect of this change on nosocomial EVD-related infections. METHODS We performed a retrospective cohort study to compare the EVD-related infection rates between 2 groups (group A, elective EVD replacement; group B, clinically indicated EVD replacement). We analyzed the data from 142 patients (group A, n = 43; group B, n = 99), with a total of 227 EVDs for 5 years and 3 months (1721 catheter days). RESULTS The overall EVD-related infection rates were elevated in group A (0.14; 32% of patients) compared with group B (0.08; 8%; P = 0.001). The median hospital stay (33 vs. 24 days; P = 0.001) and neurosurgical intensive care unit stay (30.5 vs. 17 days; P < 0.0001) were also longer for group A. The requirement for multiple EVDs was an independent risk factor (P = 0.003), with a 4.6 times greater risk in group A (odds ratio, 4.64; 95% confidence interval, 1.7-12.6). CONCLUSIONS The findings from our study strengthen an increasing body of evidence suggesting the importance of inoculation of skin flora as a critical risk factor for EVD-related infections, underscoring the importance of drain changes only when clinically indicated and that, as soon as clinically permitted, catheters should be removed.
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Affiliation(s)
- Miki Katzir
- Department of Neurosurgery, Rambam (Maimonides) Health Care Campus, Technion Israel Institute of Technology, Haifa, Israel
| | - Jason J Lefkowitz
- Technion American Medical School, The Bruce and Ruth Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Daniel Ben-Reuven
- Technion American Medical School, The Bruce and Ruth Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Steven J Fuchs
- Technion American Medical School, The Bruce and Ruth Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Khetam Hussein
- Infectious Diseases Institute, Rambam (Maimonides) Health Care Campus, The Bruce and Ruth Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Gill E Sviri
- Department of Neurosurgery, Rambam (Maimonides) Health Care Campus, Technion Israel Institute of Technology, Haifa, Israel.
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Abstract
Hospital-acquired infections are common in neurointensive care units. We sought to review interventions which may reduce infection rates in neurocritically ill populations. We conducted a systematic review of studies targeting adult patients in neuro-intensive care units (neuro-ICUs) with an intervention designed to prevent ICU-acquired infections. Our outcome of interest was change in the prevalence or rates of infection between active and control arms of these studies. We excluded studies based on the following criteria: no English full-text version available; pediatric population; non-neurosciences ICU population; pre- or intraoperative methods to prevent infection; lack of discrete data for infection rates/prevalence; studies that were purely observational in nature and did not test an intervention; and studies performed in resource limited settings. We initially retrieved 3716 results by searching the following databases: PubMed/MEDLINE, EMBASE via Ovid, and Cochrane CENTRAL via Ovid. No date or language limits were used in the search. Computerized deduplication was conducted using EndNote followed by a confirmatory manual review resulting in 3414 citations. An additional 19 manuscripts were identified through review of references. The screening process followed a standard protocol, using two screeners at the title/abstract level to determine relevance and at the full-text level to determine eligibility for inclusion. The 3427 titles/abstracts were independently screened by two board-certified neurointensivists to determine relevance for full-text review, and 3248 were rejected. The remaining 179 abstracts were reviewed in full text using predetermined inclusion/exclusion criteria. Ultimately, 75 articles met our inclusion criteria and were utilized in the final analysis. The reviewed literature highlights the need for collaborative, multi-disciplinary, and multi-pronged approaches to reduce infections. Rates of VRI, SSI, VAP, CAUTI, and CLABSI can approach zero with persistence and a team-based approach.
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Affiliation(s)
- Aaron Sylvan Lord
- Departments of Neurology and Neurosurgery, New York University School of Medicine, New York, NY, USA.
| | - Joseph Nicholson
- NYU Health Sciences Library, New York University School of Medicine, New York, NY, USA
| | - Ariane Lewis
- Departments of Neurology and Neurosurgery, New York University School of Medicine, New York, NY, USA
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Mackay CJ, Chen Y. Ruptured cerebral abscess with ventriculitis and leptomeningitis; A rare complication in the setting of metastatic esophageal cancer: Case report and literature review. Radiol Case Rep 2019; 14:782-785. [PMID: 31011379 PMCID: PMC6461570 DOI: 10.1016/j.radcr.2019.03.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 03/26/2019] [Accepted: 03/27/2019] [Indexed: 02/05/2023] Open
Abstract
Esophageal cancer is one of the deadliest cancers worldwide, and metastatic esophageal carcinoma carries a very poor prognosis. Patients tend to decline rapidly, with an overall 5-year survival rate less than 20%. Furthermore, understanding the eventual cause of death in patients with esophageal cancer may serve to guide treatment and hopefully improve the patient's quality of life. Less common causes of death in patients with metastatic esophageal cancer have infrequently been described in the literature. Our report outlines a unique case of metastatic esophageal carcinoma, complicated by ruptured intracranial abscess, with subsequent ventriculitis and leptomeningitis.
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Affiliation(s)
- Chad J Mackay
- St. Joseph's Hospital, Department of Radiology, Medical College of Wisconsin, Affiliated Hospitals, 5000 W. Chambers Street, Milwaukee, WI 53210, USA
| | - Yao Chen
- Milwaukee Radiologists Limited, Milwaukee, WI
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Headley SA, de Mello Zanim Michelazzo M, Elias B, Viana NE, Pereira YL, Pretto-Giordano LG, da Silva JF, da Silva FES, Vilas-Boas LA, da Costa Flaiban KKM, Alfieri AA, Gomes LA. Disseminated melanized fungal infection due to Cladosporium halotolerans in a dog coinfected with canine adenovirus-1 and canine parvovirus-2. Braz J Microbiol 2019; 50:859-70. [PMID: 30997656 DOI: 10.1007/s42770-019-00082-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 02/25/2019] [Indexed: 12/18/2022] Open
Abstract
This report presents the pathologic findings associated with disseminated infection due to Cladosporium halotolerans in a dog that was simultaneously infected with canine adenovirus-1 (CAdV-1) and canine parvovirus-2 (CPV-2). A 12-year-old, mixed breed dog, with a clinical history of neurological manifestations was submitted for routine autopsy due to poor prognosis. The principal pathologic findings were mycotic necrotizing nephritis, hepatitis, and splenitis with embolic dissemination to the brain resulting in mycotic necrotizing meningoencephalitis, ventriculitis, choroid plexitis, and obstructive hydrocephalus associated with intralesional and intravascular septate pigmented fungi. PCR and sequencing of the ITS region of fungi revealed that the intralesional fungal organisms had 82% nucleotide identity with members of the Cladosporium sphaerospermum complex of organisms. However, a PCR assay and sequencing of the beta tubulin gene confirmed that the organism identified in this dog had 100% nucleotide sequence identity with C. halotolerans. Using immunohistochemistry, intralesional antigens of CAdV-1 were identified within the epithelial cells of the liver and lungs; there was positive immunolabeling for CPV-2 antigens in degenerated cardiomyocytes. These findings confirmed the active participation of C. halotolerans in the development of disseminated cladosporiosis in this dog and represent a rare occurrence of concomitant infection with CAdV-1 and CPV-2.
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Olguner SK, Boyar B, Alabaz D, Erman T, Oktay K, Arslan A, Bilgin E, Okten AI. Tumor necrosis factor alpha and interleukin-1 beta levels in cerebrospinal fluid examination for the diagnosis of ventriculoperitoneal shunt-related ventriculitis. Childs Nerv Syst 2019; 35:629-636. [PMID: 30687902 DOI: 10.1007/s00381-019-04070-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 01/20/2019] [Indexed: 01/01/2023]
Abstract
PURPOSE Ventriculitis is known to develop after chronic inflammation and bacterial invasion of the ventricular surface with a recurrence of shunt infections. The aim of this study is to evaluate the diagnostic value of elevation in cerebrospinal fluid (CSF) interleukin-1 beta (IL-1β) and tumor necrosis factor alpha (TNF-α) together with CSF culture and laboratory test results in the diagnosis of ventriculoperitoneal (VP) shunt-related ventriculitis, which is known to be more problematic than conventional shunt infection. METHODS The study included a total of 34 patients with a VP shunt due to hydrocephalus, who presented with a headache, fever, and shunt infection at the Emergency Department and had a pre-diagnosis of ventriculitis. Nineteen patients were diagnosed with shunt-related infection or ventriculitis using the CSF obtained from the shunt pump. The IL-1β and TNF-α levels from the CSF samples of all patients were measured using the Micro ELISA immunoassay method. RESULTS CSF direct microscopic observation revealed that the mean cell count, IL-1β level, CRP level, and blood leukocyte level were higher in patients with ventriculitis compared to those diagnosed with shunt infection (p = 0.02, p = 0.009, p = 0.004, and p = 0.009, respectively). The probability of predicting positive culture outcome was 92.7% with 90.9% sensitivity and 82.6% specificity when IL-1β values exceeded 4.0 pg/ml. TNF-α values did not show a significant, reliable pattern compared to IL-1β. CONCLUSIONS IL-1β is a reliable parameter which shall be used in the diagnosis of ventriculitis by predicting positive culture outcome with high sensitivity and specificity.
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Affiliation(s)
- Semih K Olguner
- Department of Neurosurgery, Adana City Training Research Hospital, Adana, Turkey.
| | - Bulent Boyar
- Department of Neurosurgery, Cukurova University of Medical School, Adana, Turkey
| | - Derya Alabaz
- Pediatric Infectious Disease Department, Cukurova University of Medical School, Adana, Turkey
| | - Tahsin Erman
- Department of Neurosurgery, Cukurova University of Medical School, Adana, Turkey
| | - Kadir Oktay
- Department of Neurosurgery, Medical Park Hospital, Gaziantep, Turkey
| | - Ali Arslan
- Department of Neurosurgery, Adana City Training Research Hospital, Adana, Turkey
| | - Emre Bilgin
- Department of Neurosurgery, Adana City Training Research Hospital, Adana, Turkey
| | - Ali Ihsan Okten
- Department of Neurosurgery, Adana City Training Research Hospital, Adana, Turkey
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Bajaj D, Agrawal A, Gandhi D, Varughese R, Gupta S, Regelmann D. Intraventricular empyema caused by Neisseria meningitidis. IDCases 2019; 15:e00503. [PMID: 30788218 PMCID: PMC6369236 DOI: 10.1016/j.idcr.2019.e00503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/01/2019] [Accepted: 02/01/2019] [Indexed: 11/20/2022] Open
Abstract
Meningitis is defined as an inflammation of the protective covering of brain and spinal cord collectively called as meninges. Meningeal infection can be complicated by intraventricular empyema. There are 9 cases of intraventricular empyema described in the literature out of which only three are described to be caused by Neisseria meningitidis. We report the fourth rare case. A 61-year-old female with past medical history of diabetes and hypertension presented with the chief complaint of fever with chills and headache of 1-day duration. CT head did not reveal any acute abnormalities. Lumbar puncture was obtained and empiric IV antimicrobial agents were started. CSF analysis showed gram negative diplococci with culture growing Neisseria meningitidis suggesting meningococcal meningitis. Due to persistent headache and lethargy after complicated meningitis was suspected and MRI of brain was obtained which reflected a diagnosis of intraventricular empyema. Pyogenic ventriculitis also known as intraventricular empyema or ependymitis, is a defined as an inflammation of the ependymal lining of the cerebral ventricular system and is characterized by the presence of suppurative fluid in the ventricles. It is a health care associated complication and is often confused with meningitis due to the similar presentation. Therefore, persistent symptoms despite optimal antimicrobial therapy (therapeutic failure) should alarm the presence of pyogenic ventriculitis. This is the fourth case of intraventricular empyema reported secondary to Neisseria meningitidis. Our case reiterates that clinicians should maintain an index of suspicion for complicated meningitis in patients not responding to standard antimicrobial therapy.
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Affiliation(s)
- Divyansh Bajaj
- Department of Internal Medicine, Quinnipiac University Frank H. Netter MD School of Medicine/Saint Vincent's Medical Center, Bridgeport, CT, USA
| | - Ankit Agrawal
- Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School/Saint Peter's University Hospital, New Brunswick, NJ, USA
| | - Darshan Gandhi
- Department of Diagnostic Radiology, Quinnipiac University Frank H. Netter MD School of Medicine/Saint Vincent's Medical Center, Bridgeport, CT, USA
| | - Reba Varughese
- Department of Internal Medicine, Quinnipiac University Frank H. Netter MD School of Medicine/Saint Vincent's Medical Center, Bridgeport, CT, USA
| | - Sonali Gupta
- Department of Internal Medicine, Quinnipiac University Frank H. Netter MD School of Medicine/Saint Vincent's Medical Center, Bridgeport, CT, USA
| | - David Regelmann
- Department of Internal Medicine, Quinnipiac University Frank H. Netter MD School of Medicine/Saint Vincent's Medical Center, Bridgeport, CT, USA
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Kasimahanti R, Satish SK, Anand M. Community-acquired Escherichia coli meningitis with ventriculitis in an adult-a rare case report. J Intensive Care 2018; 6:63. [PMID: 30263123 PMCID: PMC6154823 DOI: 10.1186/s40560-018-0332-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 09/13/2018] [Indexed: 11/12/2022] Open
Abstract
Background Community-acquired gram-negative bacillary meningitis is rare to occur without preexisting conditions like trauma, organ dysfunction, and immunocompromised state, and very few case reports with Escherichia coli have been described in literature till now. Presence of ventriculitis along with meningitis makes the incidence further sparse. Case presentation A review of literature identified a total of only 45 community-acquired E. coli meningitis from 1945 till to date. Here, we have described a case of community-acquired E. coli meningitis with ventriculitis in an adult with past history of completely repaired CSF leak secondary to trauma nearly 23 years ago, without current radiological evidence of persistent CSF leak and therefore described as spontaneously acquired. Post-contrast T1 images of MRI were suggestive of subtle ependymal enhancement of ventricles, and patient was treated in lines of ventriculitis. Initial CSF was suggestive of acute pyogenic meningitis, and the organism grown was pan-sensitive E. coli. Patient was treated with antibiotics according to the culture sensitivity pattern and was given a prolonged course of 6 weeks of antibiotic therapy in view of ventriculitis. Conclusion Community-acquired E. coli meningitis with possible ventriculitis in adults is described as a rare entity and is likely to be underrated and under-recognized.
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Affiliation(s)
- Rajesh Kasimahanti
- Department of Critical Care Medicine, Yashoda Hospitals, Alexander Road, PIN: 500003, Secunderabad, Telangana India
| | | | - Mridu Anand
- Department of Microbiology, Yashoda Hospitals, Secunderabad, India
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Mahammedi A, Bachir S, Purdy J, Larvie M, Buehler M. Pyogenic brain abscess, ventriculitis and diffuse meningitis with fatal outcome in an adult: Radiologic-pathologic correlation ☆,. Radiol Case Rep 2018; 13:1063-1068. [PMID: 30228844 PMCID: PMC6137902 DOI: 10.1016/j.radcr.2018.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 04/13/2018] [Accepted: 04/13/2018] [Indexed: 10/25/2022] Open
Abstract
Rupture of brain abscesses with evolution into ventriculitis with meningitis may result in sudden and dramatic worsening of the clinical situation. We present a 57-year-old man with such an event and fatal outcome. Multiple imaging modalities including computed tomography and advanced magnetic resonance imaging were correlated with gross specimen and histologic images. The differential diagnosis of multiple lesions with ring enhancement and prominent perifocal edema includes mainly infectious and neoplastic processes, such as brain abscess, metastasis, and multicentric glioblastoma. Pyogenic ventriculitis is an uncommon manifestation of severe intracranial infection that might be clinically obscure. We discuss the characteristic magnetic resonance findings of brain abscess and its complications, including meningitis and ventriculitis with emphasis on the role of diffusion-weighted and fluid-attenuated inversion recovery imaging.
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Affiliation(s)
- Abdelkader Mahammedi
- Cleveland Clinic, Department of Neuroradiology, Neuroradiology Room L10-407, 9500 Euclid Ave., Cleveland, OH 44195, USA
| | - Suha Bachir
- Cleveland Clinic, Department of Neuroradiology, Neuroradiology Room L10-407, 9500 Euclid Ave., Cleveland, OH 44195, USA
| | - Jenna Purdy
- University of Toledo, Department of Pathology and Neuroradiology, Toledo, OH, USA
| | - Mykol Larvie
- Cleveland Clinic, Department of Neuroradiology, Neuroradiology Room L10-407, 9500 Euclid Ave., Cleveland, OH 44195, USA
| | - Mark Buehler
- University of Toledo, Department of Pathology and Neuroradiology, Toledo, OH, USA
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Abstract
Neurointensive care (NICU) patients experience complex infectious disease challenges. Central nervous system (CNS) infections are difficult to diagnose and treat, and post-neurosurgical patients are vulnerable to a unique set of healthcare-acquired infections (HAI) in addition to those typical of critically ill patients. The purpose of this review is to summarize the approach to suspected infection in the NICU and discuss management of several infectious syndromes in the NICU setting.
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Affiliation(s)
- John C O'Horo
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA. .,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Priya Sampathkumar
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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Fadel H, Moon SJ, Klinger NV, Chamiraju P, Eltahawy HA, Moisi MD, Guthikonda M. Candida parapsilosis Infection of Ventriculoperitoneal Shunt in Adult: Case Report and Literature Review. World Neurosurg 2018; 119:290-293. [PMID: 30114539 DOI: 10.1016/j.wneu.2018.08.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 07/31/2018] [Accepted: 08/02/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND Candida parapsilosis is an incredibly rare cause of ventriculoperitoneal (VP) shunt infections, with only 1 adult case reported in the literature to date. CASE DESCRIPTION We describe the case of a 45-year-old man admitted for a traumatic fall and subsequently treated with VP shunt placement for obstructive hydrocephalus secondary to a cerebellar contusion and intraventricular hemorrhage. Eight months following VP shunt placement, the patient presented with a 2-month history of clear fluid leakage through a dehiscent surgical abdominal wound overlying the distal VP shunt. Cerebrospinal fluid cultures were obtained and grew C. parapsilosis. The patient subsequently underwent VP shunt externalization and began antifungal treatment with intravenous liposomal amphotericin B. Cerebrospinal fluid studies continued to redemonstrate C. parapsilosis infection, for which VP shunt removal and external ventricular drain placement was performed. Three days into treatment with amphotericin B, he endured significant nephrotoxicity necessitating a switch to oral fluconazole. Following 3 weeks of oral fluconazole treatment with negative serial cerebrospinal fluid cultures, the patient underwent external ventricular drain removal and VP shunt insertion. Following the procedure and 22 total days of oral fluconazole treatment, our patient recovered well and was discharged to a rehabilitation facility in stable condition. CONCLUSIONS In our report, we describe the clinical course of our patient and offer a review and analysis of the most up-to-date literature concerning C. parapsilosis shunt infections, as well as treatment guidelines for central nervous system candidiasis.
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Affiliation(s)
- Hassan Fadel
- Wayne State University School of Medicine, Department of Neurosurgery, Detroit, Michigan, USA
| | - Seong-Jin Moon
- Wayne State University School of Medicine, Department of Neurosurgery, Detroit, Michigan, USA
| | - Neil V Klinger
- Wayne State University School of Medicine, Department of Neurosurgery, Detroit, Michigan, USA.
| | - Parthasarathi Chamiraju
- Wayne State University School of Medicine, Department of Neurosurgery, Detroit, Michigan, USA
| | - Hazem A Eltahawy
- Wayne State University School of Medicine, Department of Neurosurgery, Detroit, Michigan, USA
| | - Marc D Moisi
- Wayne State University School of Medicine, Department of Neurosurgery, Detroit, Michigan, USA
| | - Murali Guthikonda
- Wayne State University School of Medicine, Department of Neurosurgery, Detroit, Michigan, USA
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Demoz GT, Alebachew M, Legesse Y, Ayalneh B. Treatment of ventriculoperitoneal shunt infection and ventriculitis caused by Acinetobacter baumannii: a case report. J Med Case Rep 2018; 12:141. [PMID: 29788980 PMCID: PMC5964891 DOI: 10.1186/s13256-018-1680-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 04/03/2018] [Indexed: 11/18/2022] Open
Abstract
Background Acinetobacter baumannii (A. baumannii) infections are a recognized problem in healthcare, causing ventriculoperitoneal shunt infection and ventriculitis. Such infections are serious intracranial infection that can lead to serious complication and death. Treatment of infection caused by A. baumannii becomes difficult because of its inclination to develop pandrug resistance to the universally used antibiotics. In this case, we focused on pediatric ventriculitis/shunt infection caused by A. baumannii in an extensive follow-up and report the subsequent treatment outcome. Very limited information regarding the therapeutic options against A. baumannii ventriculitis/shunt infection is available in our hospital. Thus, we present one such case and the problems in its treatment. Case presentation We reported the case of a 6-year-old Ethiopian boy who developed ventriculitis/shunt infection from the pandrug-resistant strain of A. baumannii, after decompression of a craniotomy for medulloblastoma. Following the surgical procedure, he had developed hydrocephalus and ventriculoperitoneal shunt infection/ventriculitis as he presented with persistent fever, elevated white blood cell count, reduced glucose level, and the cerebrospinal fluid culture revealed A. baumannii, which was not responding to most of commercially available antibiotics systemically. Our patient was successfully treated with intravenous ampicillin-sulbactam. Conclusions We presented our case of pandrug-resistant A. baumannii ventriculoperitoneal shunt infection and ventriculitis successfully treated with a systemic ampicillin-sulbactam. Provision of systemic ampicillin-sulbactam should not be undermined. Therefore, this case exemplifies that intravenous administration of ampicillin-sulbactam can be a good therapeutic option against A. baumannii ventriculoperitoneal shunt infection and ventriculitis. Electronic supplementary material The online version of this article (10.1186/s13256-018-1680-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gebre Teklemariam Demoz
- Clinical Pharmacy and Pharmacy Practice Unit, Department of Pharmacy, College of Health Sciences, Aksum University, Aksum, Ethiopia.
| | - Minyahil Alebachew
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yirga Legesse
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Belete Ayalneh
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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