Ventriculitis: Infection or Inflammation

Ramanan, Mahesh; Shorr, Andrew F.; Lipman, Jeffrey

doi:10.3390/antibiotics10101246

Cited by 10 publications

(8 citation statements)

References 85 publications

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“…The clinical signs of infection and fever may be subtle, and variations in disease definitions have made diagnosis controversial. 11,12 The current recommendations are mainly based on expert opinion. 13 A low CSF glucose level and/or pleocytosis do not reliably differentiate an infection from ventricular hemorrhage.…”

Section: Introductionmentioning

confidence: 99%

“…Original/research articles Defect repair was performed to 13 neonates in the form of primary repair AE VPS AE EVD • Neonatal ventriculitis occurred in 5 of 13 (38%) patients as postsurgical complication • Outcome: NICU discharge(12), left against advice(11), and mortality of 8%• Neurologic outcome of neonates presented with ventriculitis are unknown Epidemiological surveillance for neonatal meningitis in a multicenter study in Peru • Cumulative hospital incidence: 1.4/1000 livebirths • Preterm neonates constitute 54.7% of the study population • Preexisting neonatal condition: sepsis • Common isolates: E. coli and Listeria monocytogenes • Ventriculitis and hydrocephalus were common acute and chronic neurological complications • Neonatal outcome: neurologic complications occur in 25% of the population; death in 2 neonates…”

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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: Introductionmentioning

confidence: 99%

mentioning

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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“…Conversely, weaning may increase the risk of EVD-related infection secondary to the longer duration of EVD treatment. 13 However, none of these questions have been resolved.…”

Section: Introductionmentioning

confidence: 99%

“…In theory, weaning compared to prompt closure may reduce the risk of shunt dependency or brain injury as a result of acute hydrocephalus. Conversely, weaning may increase the risk of EVD‐related infection secondary to the longer duration of EVD treatment 13 . However, none of these questions have been resolved.…”

Section: Introductionmentioning

confidence: 99%

Prompt closure versus gradual weaning of external ventricular drainage for hydrocephalus following aneurysmal subarachnoid haemorrhage: Protocol for the DRAIN randomised clinical trial

Capion,

Lilja‐Cyron,

Olsen

et al. 2023

Acta Anaesthesiol Scand

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BackgroundAneurysmal subarachnoid haemorrhage (aSAH) is a life‐threatening disease caused by rupture of an intracranial aneurysm. A common complication following aSAH is hydrocephalus, for which placement of an external ventricular drain (EVD) is an important first‐line treatment. Once the patient is clinically stable, the EVD is either removed or replaced by a ventriculoperitoneal shunt. The optimal strategy for cessation of EVD treatment is, however, unknown. Gradual weaning may increase the risk of EVD‐related infection, whereas prompt closure carries a risk of acute hydrocephalus and redundant shunt implantations. We designed a randomised clinical trial comparing the two commonly used strategies for cessation of EVD treatment in patients with aSAH.MethodsDRAIN is an international multi‐centre randomised clinical trial with a parallel group design comparing gradual weaning versus prompt closure of EVD treatment in patients with aSAH. Participants are randomised to either gradual weaning which comprises a multi‐step increase of resistance over days, or prompt closure of the EVD. The primary outcome is a composite outcome of VP‐shunt implantation, all‐cause mortality, or ventriculostomy‐related infection. Secondary outcomes are serious adverse events excluding mortality, functional outcome (modified Rankin scale), health‐related quality of life (EQ‐5D) and Fatigue Severity Scale (FSS). Outcome assessment will be performed 6 months after ictus. Based on the sample size calculation (event proportion 80% in the gradual weaning group, relative risk reduction 20%, type I error 5%, power 80%), 122 patients are needed in each intervention group. Outcome assessment for the primary outcome, statistical analyses and conclusion drawing will be blinded.Trial RegistrationClinicalTrials.gov identifier: NCT03948256.

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“…9,10 The lack of clarity in the diagnostic criteria for VRI creates problems for clinicians. While underdiagnosis may lead to missed opportunities to intervene and reduce preventable morbidity and mortality, 11 over treatment is associated with potential adverse events. 12 It is not clear how the various diagnostic criteria for VRI are implemented in routine clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Variation in the Incidence of ventriculostomy related infection in critically ill patients

Bassin

Tian

Chadwick

et al. 2022

Preprint

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IntroductionVentriculostomy related infection (VRI) or ventriculitis is a common and serious complication related to the placement of an external ventricular drain. Numerous sets of diagnostic criteria for VRI have been reported. We sought to estimate the variation in the incidence of VRI in a cohort of patients according to published diagnostic criteria.Materials and MethodsWe conducted a retrospective cohort study. We included adult patients admitted to the Neuroscience intensive care unit with traumatic brain injury (TBI), subarachnoid haemorrhage (SAH) and intracerebral haemorrhage (ICH) who required an EVD. We estimated the incidence of VRI according to published diagnostic criteria. We compared the incidence to clinicians’ diagnoses of VRI. The primary outcome was the estimated incidence of VRI.ResultsThere were 190 study participants, median age (interquartile range) of 58 (48 - 72), 106 (55.8%) were female. Admitting diagnoses was ICH in 30 (15.8%), TBI in 49 (25.8%) and SAH in 111 (58.4%) of cases respectively. There were 158 (83.2%) who required mechanical ventilation for a median of 6 (2-13) days. There were 29 (15.3%) who were treated for VRI by clinicians, with 6 (3.2%) having a positive culture. Variation in the diagnostic criteria led to an estimated incidence of VRI that ranged from 1 (0.5%) to 178 (93.7%).ConclusionIn this critically ill cohort, the estimated incidence of VRI varied widely depending on which diagnostic criteria for VRI were applied. A comprehensive, consistent, objective and universal set of diagnostic criteria for ventriculostomy related infection is needed.

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Ventriculitis: Infection or Inflammation

Cited by 10 publications

References 85 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

Prompt closure versus gradual weaning of external ventricular drainage for hydrocephalus following aneurysmal subarachnoid haemorrhage: Protocol for the DRAIN randomised clinical trial

Variation in the Incidence of ventriculostomy related infection in critically ill patients

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