John J Lewin1, Aaron M Cook2, Cynthia Gonzales3, David Merola4, Ron Neyens5, William J Peppard6,7, Gretchen M Brophy8, Lisa Kurczewski8, Melissa Giarratano9, Jason Makii10, A Shaun Rowe11, Eljim P Tesoro12, Amber Zaniewski13, Sarah Clark14, Wendy C Ziai15. 1. Department of Pharmacy, The Johns Hopkins Hospital, and Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Carnegie 180, Baltimore, MD, 21287, USA. Jlewin3@jhmi.edu. 2. UK Healthcare, University of Kentucky, Lexington, USA. 3. University of California San Diego School of Medicine, San Diego, USA. 4. Bernard J. Dunn School of Pharmacy, Shenandoah University, Winchester, USA. 5. Medical University of South Carolina, Charleston, USA. 6. Department of Pharmacy, Froedtert Hospital, Wauwatosa, USA. 7. Department of Trauma & Critical Care, Medical College of Wisconsin, Milwaukee, USA. 8. Virginia Commonwealth University Medical College of Virginia Campus, Richmond, USA. 9. Tampa General Hospital, Tampa, USA. 10. University Hospitals Cleveland Medical Center, Cleveland, USA. 11. Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, USA. 12. University of Illinois Hospital and Health Sciences System, Chicago, USA. 13. Yale-New Haven Hospital, New Haven, USA. 14. Mayo Clinic, Rochester, USA. 15. Departments of Neurology and Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA.
Abstract
BACKGROUND: Central nervous system (CNS) infections are particularly prevalent in the adult neurocritical care patient population and are associated with significant morbidity and mortality. Factors relevant to the nature of CNS infections pose significant challenges to clinicians treating afflicted patients. Intraventricular (IVT) administration of antibiotics may offer several benefits over systemic therapy; however, the outcomes and current practices of such treatments are poorly described in the literature. OBJECTIVE: To describe current practices and outcomes of patients receiving intraventricular antibiotic treatment for CNS infections in neurological intensive care units of academic medical centers nationwide. METHODS: A retrospective cohort study was conducted on patients admitted to intensive care units who received IVT antibiotic treatment at participating centers in the USA between January 01, 2003, and December 31, 2013. Clinical and laboratory parameters, microbiology, surgical and antimicrobial management, and treatment outcomes were collected and described. RESULTS: Of the 105 patients included, all received systemic antimicrobial therapy along with at least one dose of IVT antimicrobial agents. Intraventricular vancomycin was used in 52.4% of patients. The average dose was 12.2 mg/day for a median duration of 5 days. Intraventricular aminoglycosides were used in 47.5% of the patients, either alone or in combination with IVT vancomycin. The average dose of gentamicin/tobramycin was 6.7 mg/day with a median duration of 6 days. Overall mortality was 18.1%. Cerebrospinal fluid (CSF) culture sterilization occurred in 88.4% of the patients with a rate of recurrence or persistence of positive cultures of 9.5%. CONCLUSION: Intraventricular antimicrobial agents resulted in a high CSF sterilization rate. Contemporary use of this route typically results in a treatment duration of less than a week. Prospective studies are needed to establish the optimal patient population, as well as the efficacy and safety of this route of administration.
BACKGROUND: Central nervous system (CNS) infections are particularly prevalent in the adult neurocritical care patient population and are associated with significant morbidity and mortality. Factors relevant to the nature of CNS infections pose significant challenges to clinicians treating afflicted patients. Intraventricular (IVT) administration of antibiotics may offer several benefits over systemic therapy; however, the outcomes and current practices of such treatments are poorly described in the literature. OBJECTIVE: To describe current practices and outcomes of patients receiving intraventricular antibiotic treatment for CNS infections in neurological intensive care units of academic medical centers nationwide. METHODS: A retrospective cohort study was conducted on patients admitted to intensive care units who received IVT antibiotic treatment at participating centers in the USA between January 01, 2003, and December 31, 2013. Clinical and laboratory parameters, microbiology, surgical and antimicrobial management, and treatment outcomes were collected and described. RESULTS: Of the 105 patients included, all received systemic antimicrobial therapy along with at least one dose of IVT antimicrobial agents. Intraventricular vancomycin was used in 52.4% of patients. The average dose was 12.2 mg/day for a median duration of 5 days. Intraventricular aminoglycosides were used in 47.5% of the patients, either alone or in combination with IVT vancomycin. The average dose of gentamicin/tobramycin was 6.7 mg/day with a median duration of 6 days. Overall mortality was 18.1%. Cerebrospinal fluid (CSF) culture sterilization occurred in 88.4% of the patients with a rate of recurrence or persistence of positive cultures of 9.5%. CONCLUSION: Intraventricular antimicrobial agents resulted in a high CSF sterilization rate. Contemporary use of this route typically results in a treatment duration of less than a week. Prospective studies are needed to establish the optimal patient population, as well as the efficacy and safety of this route of administration.
Entities:
Keywords:
Brain abscess; Central nervous system infections; Cerebral ventriculitis; Drug resistance, microbial; Injections, intraventricular; Meningitis
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