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Current Practices of Intraventricular Antibiotic Therapy in the Treatment of Meningitis and Ventriculitis: Results from a Multicenter Retrospective Cohort Study

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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.

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Acknowledgements

This work was conducted through the Neurocritical Care Society Pharmacy Research Committee.

Funding

This publication was made possible by the Johns Hopkins Institute for Clinical and Translational Research (ICTR) which is funded in part by Grant Number UL1 TR001079 from the National Center for Advancing Translational Sciences (NCATS) a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the Johns Hopkins ICTR, NCATS or NIH.

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Authors and Affiliations

  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

    John J. Lewin III

  2. Departments of Neurology and Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA

    Wendy C. Ziai

  3. UK Healthcare, University of Kentucky, Lexington, USA

    Aaron M. Cook

  4. University of California San Diego School of Medicine, San Diego, USA

    Cynthia Gonzales

  5. Bernard J. Dunn School of Pharmacy, Shenandoah University, Winchester, USA

    David Merola

  6. Medical University of South Carolina, Charleston, USA

    Ron Neyens

  7. Department of Pharmacy, Froedtert Hospital, Wauwatosa, USA

    William J. Peppard

  8. Department of Trauma & Critical Care, Medical College of Wisconsin, Milwaukee, USA

    William J. Peppard

  9. Virginia Commonwealth University Medical College of Virginia Campus, Richmond, USA

    Gretchen M. Brophy & Lisa Kurczewski

  10. Tampa General Hospital, Tampa, USA

    Melissa Giarratano

  11. University Hospitals Cleveland Medical Center, Cleveland, USA

    Jason Makii

  12. Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, USA

    A. Shaun Rowe

  13. University of Illinois Hospital and Health Sciences System, Chicago, USA

    Eljim P. Tesoro

  14. Yale-New Haven Hospital, New Haven, USA

    Amber Zaniewski

  15. Mayo Clinic, Rochester, USA

    Sarah Clark

Authors
  1. John J. Lewin III
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  2. Aaron M. Cook
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  3. Cynthia Gonzales
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  4. David Merola
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  5. Ron Neyens
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  6. William J. Peppard
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  8. Lisa Kurczewski
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  9. Melissa Giarratano
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  10. Jason Makii
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  11. A. Shaun Rowe
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  12. Eljim P. Tesoro
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  13. Amber Zaniewski
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  14. Sarah Clark
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  15. Wendy C. Ziai
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Contributions

JL, CG, WZ conceived of and planned the study. CG, JL developed the data collection tool with input from all authors. All listed authors participated in data collection for their respective centers. Statistical analyses were conducted by AC, DM, WZ, and JL. JL and AC took the lead in writing the manuscript, with assistance from DM. All authors reviewed the manuscript and provided substantive input and edits. All authors provided critical feedback and helped shape the research, analysis and manuscript.

Corresponding author

Correspondence to John J. Lewin III.

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Conflicts of interest

Drs. Lewin, Rowe, Cook, Zaniewski, Clark, Merola, Makii, Kurczewski, Peppard, Giarratano, Gonzales, Neyens, and Brophy have nothing to disclose. Dr. Tesoro reports personal fees from Arbor Pharmaceuticals, outside the submitted work. Dr. Ziai reports personal fees from Headsense, Inc., outside the submitted work.

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Lewin, J.J., Cook, A.M., Gonzales, C. et al. Current Practices of Intraventricular Antibiotic Therapy in the Treatment of Meningitis and Ventriculitis: Results from a Multicenter Retrospective Cohort Study. Neurocrit Care 30, 609–616 (2019). https://doi.org/10.1007/s12028-018-0647-0

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  • DOI: https://doi.org/10.1007/s12028-018-0647-0

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