Intraventricular Vancomycin Treatment for Shunt-related Ventriculitis Caused by Methicillin-resistant Staphylococcus Aureus in a Preterm Infant

Helgason, Einar A.; Oskarsdottir, Thorunn; Brynjarsson, Hrolfur; Ólafsson, Ingvar Hákon; Thors, Valtýr

doi:10.1097/inf.0000000000003403

Cited by 4 publications

(5 citation statements)

References 19 publications

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“…No guideline on IVT antibiotic administration in neonates has appeared since that of the 2012 Cochrane database, 8 but several publications reported successful IVT therapy for infections caused by MDR bacteria. 6 14 16 17 20 22 24 28 30 31 35 37 39 40 The drug of choice depends on the nature and antibiotic susceptibility of the pathogen. Aminoglycosides (amikacin, gentamycin, tobramycin, netilmicin, and streptomycin), polymyxins (colistin, polymyxin B, and daptomycin), glycopeptides (vancomycin and teicoplanin), quinupristin-dalfopristin, tigecycline, and antifungals including amphotericin-B and caspofungin can be delivered IVT.…”

Section: Discussionmentioning

confidence: 99%

“…Another search on Google Scholar was performed to identify articles published in non-PubMed indexed journals. Seven publications were found, so we finally reviewed 37 texts (20 case reports, 6 case series, 6 7 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 and 11 original articles 2 3 9 38 39 40 41 42 43 44 45 [5 retrospective and 3 epidemiological surveillance studies, 1 prospective observational study, 1 pilot population pharmacokinetic modeling study, and 1 research article]).…”

Section: Methodsmentioning

confidence: 99%

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Challenges in Diagnosis and Treatment of Neonatal Ventriculitis: A Case Report and Systematic Review of Difficult-to-Treat Central Nervous System Infection Resistant to Conventional Therapy

Ongun,

Kihtir,

Zarif

et al. 2024

J Pediatr Infect Dis

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Objective Ventriculitis is an example of the increasing global trend in difficult-to-treat infections in neonates caused by pathogens resistant to conventional therapies. This article describes the first use of intravenous and intraventricular tigecycline to treat ventriculitis caused by vancomycin-resistant enterococci in a preterm neonate and systematically review the literature on challenges posed by the definitions, diagnosis, and treatment of neonatal ventriculitis Methods The authors searched PubMed and Internet search engines for “ventriculitis” in the period from 2003 to 2023 restricting the research to “Newborn,” “Human,” “English language,” and “full-text availability.” Results Thirty-seven publications (20 case reports, 6 case series, and 11 research articles) were extracted upon research. Preterm birth, posthemorrhagic ventricular dilatation requiring placement of ventricular access devices, and sepsis preceded neonatal ventriculitis. Infections caused by rare microorganisms, in particular gram-negative bacteria resistant to conventional therapies, predominated in the publications describing the need for a combination of intravenous (IV) and intraventricular (IVT) therapies. Survivors of neonatal ventriculitis developed neurodevelopmental impairments such as hydrocephalus, seizures, motor function, hearing, and vision impairment. Conclusion Clinical suspicion of ventriculitis indicated by subtle signs is key for prompt diagnosis. Effective IV and IVT antibiotics are essential to prevent serious sequelae and mortality. The drug delivery method should be changed if there is no clinical response. This study emphasizes the urgent need for pediatric trials of antibiotics against organisms resistant to other drugs.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Challenges in Diagnosis and Treatment of Neonatal Ventriculitis: A Case Report and Systematic Review of Difficult-to-Treat Central Nervous System Infection Resistant to Conventional Therapy

Ongun,

Kihtir,

Zarif

et al. 2024

J Pediatr Infect Dis

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“…No guideline on IVT antibiotic administration in neonates has appeared since that of the 2012 Cochrane database, 8 but several publications reported successful IVT therapy for infections caused by MDR bacteria. 6,14,16,17,20,22,24,28,30,31,35,37,39,40 The drug of choice depends on the nature and antibiotic susceptibility of the pathogen. Aminoglycosides (amikacin, gentamycin, tobramycin, netilmicin, and streptomycin), polymyxins (colistin, polymyxin B, and daptomycin), glycopeptides (vancomycin and teicoplanin), quinupristin-dalfopristin, tigecycline, and antifungals including amphotericin-B and caspofungin can be delivered IVT.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2024

J Pediatr Infect Dis

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Objective Ventriculitis is an example of the increasing global trend in difficult-to-treat infections in neonates caused by pathogens resistant to conventional therapies. This article describes the first use of intravenous and intraventricular tigecycline to treat ventriculitis caused by vancomycin-resistant enterococci in a preterm neonate and systematically review the literature on challenges posed by the definitions, diagnosis, and treatment of neonatal ventriculitis Methods The authors searched PubMed and Internet search engines for "ventriculitis" in the period from 2003 to 2023 restricting the research to "Newborn," "Human," "English language," and "full-text availability." Results Thirty-seven publications (20 case reports, 6 case series, and 11 research articles) were extracted upon research. Preterm birth, posthemorrhagic ventricular dilatation requiring placement of ventricular access devices, and sepsis preceded neonatal ventriculitis. Infections caused by rare microorganisms, in particular gramnegative bacteria resistant to conventional therapies, predominated in the publications describing the need for a combination of intravenous (IV) and intraventricular (IVT) therapies. Survivors of neonatal ventriculitis developed neurodevelopmental impairments such as hydrocephalus, seizures, motor function, hearing, and vision impairment. Conclusion Clinical suspicion of ventriculitis indicated by subtle signs is key for prompt diagnosis. Effective IV and IVT antibiotics are essential to prevent serious sequelae and mortality. The drug delivery method should be changed if there is no clinical response. This study emphasizes the urgent need for pediatric trials of antibiotics against organisms resistant to other drugs.

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“…Our analysis included 19 studies using intraventricular antibiotics in neonates undergoing neurosurgery, comprising 59 patients (Supplement 1). Most of these studies are case reports [19][20][21][22][23][24][25][26][27][28][29][30][31] or small case series [32][33][34][35] , with very few small comparative studies (cohorts). 36,10 Another 26 studies on neonates also used intraventricular antibiotics to treat neuroinfections in neurosurgery, but they were not included in our analysis because the outcomes of interest were not specified in sufficient detail.…”

Section: A) Intraventricular Antibiotics In Neurosurgerymentioning

confidence: 99%

“…However, a lower morbidity was found among patients treated with intraventricular antibiotics (33% vs. 75%, P=0. 19). 54 When analyzing the total administered doses of intraventricular antibiotics, we found a decreased mortality in studies in which a minimum dose of ≥ 3 days (mortality: 4.3%) of intraventricular antibiotic was administered as compared to those who did not use intraventricular antibiotics (mortality: 17%, P=0.01) (Table 4).…”

Section: Research In Pediatricsmentioning

confidence: 99%

Systematic review and meta-analysis of intraventricular antibiotics for neonatal meningitis and ventriculitis

Valdivia,

Pérez,

Vega

et al. 2023

Childs Nerv Syst

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Background: Many pediatric and neurosurgical studies have been published regarding intraventricular antibiotics in neonatal meningitis and ventriculitis. 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:We systematically reviewed scientific literature from the PubMed, EMBASE, LILACS, and SCOPUS databases. 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 multidrugresistant 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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Intraventricular Vancomycin Treatment for Shunt-related Ventriculitis Caused by Methicillin-resistant Staphylococcus Aureus in a Preterm Infant

Cited by 4 publications

References 19 publications

Challenges in Diagnosis and Treatment of Neonatal Ventriculitis: A Case Report and Systematic Review of Difficult-to-Treat Central Nervous System Infection Resistant to Conventional Therapy

Challenges in Diagnosis and Treatment of Neonatal Ventriculitis: A Case Report and Systematic Review of Difficult-to-Treat Central Nervous System Infection Resistant to Conventional Therapy

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Systematic review and meta-analysis of intraventricular antibiotics for neonatal meningitis and ventriculitis

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