Neurodevelopment Outcome of Neonates Treated With Intraventricular Colistin for Ventriculitis Caused by Multiple Drug-Resistant Pathogens—A Case Series

Hussain, Kashif; Salat, Muhammad Sohail; Gul, Ambreen; Iqbal, Javaid

doi:10.3389/fped.2020.582375

Cited by 11 publications

(26 citation statements)

References 56 publications

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“…Our patient had developed multiple brain abscesses which were managed successfully via thorough medical and neurosurgical treatments. Multi Drug Resistance -Gram Negative bacterial neonatal infections including intracranial infections is a great concern of increased prevalence in some middle and low-income countries which leads to greater morbidity and mortality rates [8]. Thus, despite negative blood and CSF culture results which might be due to technical issues, our patient was started on Intravenous Colistin in combination with Rifampin and Ciprofloxacin.…”

Section: Discussionmentioning

confidence: 97%

“…Due to limited penetration of Colistin into the blood brain barrier, simultaneous administration of Colistin via an EVD may enhance survival and improve neurodevelopmental outcomes [8,11]. However, there is limited data on using intraventricular Colistin in neonatal intracranial infections.…”

Section: Discussionmentioning

confidence: 99%

“…Multi Drug Resistance -Gram Negative bacterial neonatal intracranial infections are a great concern of increased prevalence in some middle and low-income countries which leads to greater morbidity and mortality rates. Colistin is a polymyxin antibiotic used to treat bacterial infections caused by susceptible gram-negative bacteria but has a limited penetration into blood brain barrier and there is limited data on intraventricular administration of Colistin in neonatal intracranial infections, thus, more clinical research is needed to obtain more accurate results [8]. We present a case of neonatal multiple brain abscesses and given a few case report satisfactory results on intracranial Colistin administration in cases similar to ours, we prescribed intracranial Colistin therapy along with intravenous antibiotics in the hope of achieving better therapeutic results.…”

Section: Introductionmentioning

confidence: 99%

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Intra Ventricular Colistin in Neonatal Brain Abscess Management: A Case of Multiple Brain Abscesses

Choobdar¹,

Soltani²,

Nateghian³

et al. 2022

AJP

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Neonatal Brain abscess is a rare sever neonatal infection requiring careful medical and neurosurgical intervention strategies to reduce morbidity and mortality rates. Gram-negative bacterial agents are the most common pathogens involved in brain abscesses of neonates. The use of wide spectrum antibiotics in combination with neurosurgical drainage of abscesses larger than 2.5 cm is the mainstay of treatment. Colistin is a polymyxin antibiotic used to treat bacterial infections caused by susceptible gram-negative bacteria but with a limited penetration in blood brain barrier. However, there is limited data on using intraventricular Colistin in neonatal intracranial infections. A 12-day-old male neonate with multiple brain abscesses in frontal and parietal lobes is presented. The abscesses were successfully managed with a combination of intravenous antimicrobial agents, intraventricular Colistin and concurrent administration of Interferon-ɣ. Subsequently, he developed ventriculomegaly which was successfully managed by endoscopic third ventriculostomy. He had an acceptable neurologic outcome. Due to reduced penetration of colistin in blood brain barrier, use of intraventricular Colistin in combination with its intravenous form can be beneficial in management of neonatal brain abscesses. Concurrent administration of Interferon-ɣ may improve the treatment process and outcome given that reduced secretion of this agent by neonatal T lymphocytes may contribute to a partial immunodeficiency state at this period of life.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Intra Ventricular Colistin in Neonatal Brain Abscess Management: A Case of Multiple Brain Abscesses

Choobdar¹,

Soltani²,

Nateghian³

et al. 2022

AJP

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“…A recent study addressed the use of colistin in neonates, which is one of the largest series of its kind, and the authors found that six out of seven patients who received IT/IVT colistin survived, where five of them received it in combination with IV colistin, and the one that died received only IT/IVY colistin [ 29 ]. The study went on further to report the neurodevelopmental outcome.…”

Section: Discussionmentioning

confidence: 99%

“…The study went on further to report the neurodevelopmental outcome. The authors reported three patients who had a seizure disorder on follow-up, and the only patient with moderate disability had both hearing and visual impairments [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Intrathecal/Intraventricular Colistin for Antibiotic-Resistant Bacterial CNS Infections in Pediatric Population: A Systematic Review

Alnaami

Alahmari

2022

TropicalMed

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Central nervous system (CNS) infections constitute a life-threatening condition, especially in children. Treatment limitations exist for drug-resistant CNS bacterial infections. Inadequate CNS penetration and intravenous (IV) antibiotic treatment failure represent a major clinical challenge. However, patients with antibiotic-resistant bacterial CNS infections may benefit from intrathecal (IT) or intraventricular (IVT) colistin. The authors aimed to assess the safety and effectiveness of IT/IVT colistin therapy in the pediatric population, with or without other antibiotics, for the treatment of antibiotic-resistant CNS infections. A comprehensive literature search was conducted using the electronic databases of PubMed, Ovid, and Embase for relevant articles using the following terms: “Colistin”, “CNS infection”, and “Outcome”, as well as their combinations. The retrieved articles were filtered by age (Child), language (English), route of administration (IT/IVT), and species (Humans). The present systematic review comprised 20 articles that included 31 children (19; 61.2% were boys) with multidrug-resistant CNS infection. Their ages ranged from less than one month to 18 years (median: 9 months). Acinetobacter baumannii was the main causative organism in 22 patients (70.9%), and infection occurred mainly after neurosurgical interventions (83.8%). An external ventricular drain was inserted to administer colistin into the ventricular system in 29 cases (93.5%). The median duration for colistin therapy was 18 days. Twenty-three patients (74%) recovered, while five patients (16%) had residual disability, and three patients (10%) died. The authors concluded that IT/IVT colistin therapy is safe and effective as either the primary or adjunct treatment for antibiotic-resistant cases with CNS infection.

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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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Neurodevelopment Outcome of Neonates Treated With Intraventricular Colistin for Ventriculitis Caused by Multiple Drug-Resistant Pathogens—A Case Series

Cited by 11 publications

References 56 publications

Intra Ventricular Colistin in Neonatal Brain Abscess Management: A Case of Multiple Brain Abscesses

Intra Ventricular Colistin in Neonatal Brain Abscess Management: A Case of Multiple Brain Abscesses

Intrathecal/Intraventricular Colistin for Antibiotic-Resistant Bacterial CNS Infections in Pediatric Population: A Systematic Review

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

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