Ronny Beer1, Bettina Pfausler, Erich Schmutzhard. 1. Department of Neurology, Neurological Intensive Care Unit, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria.
Abstract
INTRODUCTION: Neurocritical care patients requiring external ventricular drainage are at risk for the development of a device-related infection. Infection rate of external ventriculostomy catheters is high with reported incidences ranging from 5% up to more than 20%. Nosocomial ventriculitis or ventriculomeningitis are potential life-threatening conditions which may contribute to a permanent adverse outcome of the patient. Reducing morbidity and mortality is strongly dependent on prompt diagnosis and on the initiation of appropriate antiinfective therapy. SCIENTIFIC BACKGROUND: Management of nosocomial ventriculitis is challenging and needs to consider the most likely pathogens involved, local resistance patterns, the nature of the underlying disease, patient factors such as age, comorbidity, and immune status. Further, decisions on catheter exchange and the type and duration of systemic or local antimicrobial therapy have to be made. Because so many factors have to be taken into account, it is evident that the diagnostic and therapeutic approach to nosocomial ventriculitis is difficult to standardize. Staphylococci are the pathogens most frequently identified in nosocomial ventriculitis. Therefore, initial treatment with an antistaphylococcal agent with adequate cerebrospinal fluid penetration may be considered as first-line therapy for this infection. CONCLUSION: In the review of a contemporary case we will discuss important issues in the management of device-related ventriculitis.
INTRODUCTION:Neurocritical carepatients requiring external ventricular drainage are at risk for the development of a device-related infection. Infection rate of external ventriculostomy catheters is high with reported incidences ranging from 5% up to more than 20%. Nosocomial ventriculitis or ventriculomeningitis are potential life-threatening conditions which may contribute to a permanent adverse outcome of the patient. Reducing morbidity and mortality is strongly dependent on prompt diagnosis and on the initiation of appropriate antiinfective therapy. SCIENTIFIC BACKGROUND: Management of nosocomial ventriculitis is challenging and needs to consider the most likely pathogens involved, local resistance patterns, the nature of the underlying disease, patient factors such as age, comorbidity, and immune status. Further, decisions on catheter exchange and the type and duration of systemic or local antimicrobial therapy have to be made. Because so many factors have to be taken into account, it is evident that the diagnostic and therapeutic approach to nosocomial ventriculitis is difficult to standardize. Staphylococci are the pathogens most frequently identified in nosocomial ventriculitis. Therefore, initial treatment with an antistaphylococcal agent with adequate cerebrospinal fluid penetration may be considered as first-line therapy for this infection. CONCLUSION: In the review of a contemporary case we will discuss important issues in the management of device-related ventriculitis.
Authors: Jennifer A Frontera; Andres Fernandez; J Michael Schmidt; Jan Claassen; Katja E Wartenberg; Neeraj Badjatia; Augusto Parra; E Sander Connolly; Stephan A Mayer Journal: Neurosurgery Date: 2008-01 Impact factor: 4.654
Authors: Stefan T Gerner; Joji B Kuramatsu; Henning Abel; Stephan P Kloska; Hannes Lücking; Ilker Y Eyüpoglu; Arnd Doerfler; Stefan Schwab; Hagen B Huttner Journal: Neurocrit Care Date: 2014-12 Impact factor: 3.210