Intraventricular Cerebrospinal Fluid Antibiotic Concentrations in Patients with Intraventricular Infections

Abstract

The antibiotic concentration of the fluid from either lateral ventricle was determined 104 times in 37 patients through direct ventricular puncture, external ventricular drainage (EVD), or cerebrospinal fluid shunt sampling. The patients were 1 month to 12 years old. When the patients were receiving maximal intravenous antibiotic therapy alone, the concentrations for the most part were below 5 microgram/ml, whereas patients receiving an antibiotic through direct ventricular puncture, EVD, or a shunt reservoir usually had concentrations over 5 microgram/ml. However, wide variations from patient to patient were found with all forms of treatment despite similar dosages. Clustering of the concentration tended to occur in each individual patient. The authors conclude that, to obtain a high concentration of an antibiotic in the ventricular fluid, one should administer it directly into the ventricle.

Effects of Antimicrobial Agents Used for Therapy of CNS Infections on Dissociated Brain Cell Cultures

“…Histopathologic changes in rabbits due to gentamicin included ependymal and brain cell damages (4,5). The highest antibiotic concentrations studied in our experiments correspond to the peak values in CSF attained by intraventricular administration in patients (6,7,23,24,42). To imitate the clinical situation of intraventricular therapy the study drugs were taken from regular injectable drug vials as sodium or sulfate salts.…”

“…The major therapeutic problems of these CNS infections are antibiotic resistance of involved, often nosocomially acquired, gram-negative and gram-positive pathogens, and limited drug penetration into CSF because of narrow therapeutic drug index or only low-grade meningeal inflammation (6,7). Therefore, to produce larger antibiotic concentrations in CSF direct drug inoculation is often recommended in addition to systemic therapy (6,7,23,24,42). Neurotoxicity represents a potential hazard for intraventricular antibiotic administration and has been clinically and experimentally repeatedly observed ( 1, 2, 4, 23-25).…”

Infecções de derivações liquóricas em crianças: revisão de 100 infecções em 87 crianças

“…A substituição imediata da derivação por outra definitiva pode ser difícil se o sistema apresentar bom funcionamento e os ventrículos forem pequenos 22 . Por este motivo muitas vezes somos obrigados a optar por substituições tardias, principalmente em crianças maiores em que não é possível a realização de punções ventriculares aliviadoras, procedimento que deve ser evitado pelo risco de hemorragias, contaminações secundárias e desenvolvimento de cistos porencefálicos 10,14 . Poucos estudos comparam a eficácia da troca imediata ou tardia do sistema de derivação infectado 24 .…”

Staphylococcus aureus ventriculitis treated with single-dose intraventricular vancomycin or daptomycin (LY146032): bacterial and antibiotic kinetics in hydrocephalic rabbits

“…Experimental investigation of the treatment for staphylococcal ventriculitis is surprisingly lacking, and all treatment guidelines are empiric and based on clinical experience. Problems with studies of clinical ventriculitis include a lack of data on quantitative bacterial concentrations in cerebrospinal fluid (CSF) and wide variations in intraventricular antibiotic concentrations for a given dose (1,14,15,34,36,39).Vancomycin is the most common antibiotic given by the intraventricular route at our institution and is often used in the treatment of staphylococcal ventriculitis (1,2,9,10,26,31,41). Daptomycin (LY146032) (Eli Lilly & Co., Indianapolis, Ind.)…”

“…Experimental investigation of the treatment for staphylococcal ventriculitis is surprisingly lacking, and all treatment guidelines are empiric and based on clinical experience. Problems with studies of clinical ventriculitis include a lack of data on quantitative bacterial concentrations in cerebrospinal fluid (CSF) and wide variations in intraventricular antibiotic concentrations for a given dose (1,14,15,34,36,39).…”