Infections of cerebrospinal fluid diversion devices in adults: The role of intraventricular antimicrobial therapy.
J Infect. 2012 Nov 26;
Authors: Wilkie MD, Hanson MF, Statham PF, Brennan PM
OBJECTIVES: The precise role for intraventricular (IVT) antimicrobials in combination with systemic antibiotics in management of cerebrospinal fluid (CSF) diversion device-associated infections is uncertain. We evaluated our current practice, comparing dual therapy against systemic antimicrobials alone. METHODS: All adult patients with at least 2 consecutive CSF isolates who were treated for CSF diversion device-related infection over a 5-year period (2005-2010) were identified retrospectively. Clinical and laboratory parameters, microbiology, surgical and antimicrobial management, and treatment outcomes were analysed. RESULTS: Forty-eight patients were identified - 25 received IVT and systemic antibiotics (group A), and 23 systemic antibiotics alone (group B). Clinical features were similar between groups, as were causative organisms. CSF leucocyte counts differed slightly (A>B, p=0.067) but no laboratory parameters differed significantly. Infected devices were generally revised (A=92%, B=91%). Mean times to CSF sterilisation and normalisation of CSF microscopy were significantly shorter for group A (p<0.05 and p<0.005 respectively), as was duration of hospital stay (p<0.002) and required length of systemic antimicrobial therapy (p<0.001). CONCLUSIONS: Our findings indicate that IVT antibiotics enhance clinical and microbiological recovery and should therefore be considered for patients with CSF infection associated with a CSF diversion device. We recommend further evaluation of this approach in a prospective, randomised, controlled trial.
PMID: 23195031 [PubMed - as supplied by publisher]