Infections of cerebrospinal fluid diversion devices in adults: The role of intraventricular antimicrobial therapy
Summary Objectives The precise role for intraventricular (IVT) antimicrobials in combination with systemic antibiotics in management of cerebrospinal fluid (CSF) diversion device-associated infections is uncertain. We evaluated our current practice, comparing dual therapy against systemic antimicrob...
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| Veröffentlicht in: | The Journal of infection 2013-03, Vol.66 (3), p.239-246 |
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| creator | Wilkie, M.D Hanson, M.F Statham, P.F Brennan, P.M |
| description | Summary Objectives The precise role for intraventricular (IVT) antimicrobials in combination with systemic antibiotics in management of cerebrospinal fluid (CSF) diversion device-associated infections is uncertain. We evaluated our current practice, comparing dual therapy against systemic antimicrobials alone. Methods All adult patients with at least two consecutive CSF isolates who were treated for CSF diversion device-related infection over a 5-year period (2005–2010) were identified retrospectively. Clinical and laboratory parameters, microbiology, surgical and antimicrobial management, and treatment outcomes were analysed. Results Forty-eight patients were identified – 25 received IVT and systemic antibiotics (group A), and 23 systemic antibiotics alone (group B). Clinical features were similar between groups, as were causative organisms. CSF leucocyte counts differed slightly ( A > B , p = 0.067) but no laboratory parameters differed significantly. Infected devices were generally revised ( A = 92%, B = 91%). Mean times to CSF sterilisation and normalisation of CSF microscopy were significantly shorter for group A ( p |
| doi_str_mv | 10.1016/j.jinf.2012.11.006 |
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We evaluated our current practice, comparing dual therapy against systemic antimicrobials alone. Methods All adult patients with at least two consecutive CSF isolates who were treated for CSF diversion device-related infection over a 5-year period (2005–2010) were identified retrospectively. Clinical and laboratory parameters, microbiology, surgical and antimicrobial management, and treatment outcomes were analysed. Results Forty-eight patients were identified – 25 received IVT and systemic antibiotics (group A), and 23 systemic antibiotics alone (group B). Clinical features were similar between groups, as were causative organisms. CSF leucocyte counts differed slightly ( A > B , p = 0.067) but no laboratory parameters differed significantly. Infected devices were generally revised ( A = 92%, B = 91%). Mean times to CSF sterilisation and normalisation of CSF microscopy were significantly shorter for group A ( p < 0.05 and p < 0.005 respectively), as was duration of hospital stay ( p < 0.002) and required length of systemic antimicrobial therapy ( p < 0.001). Conclusions Our findings indicate that IVT antibiotics enhance clinical and microbiological recovery and should therefore be considered for patients with CSF infection associated with a CSF diversion device. We recommend further evaluation of this approach in a prospective, randomised, controlled trial.</description><identifier>ISSN: 0163-4453</identifier><identifier>EISSN: 1532-2742</identifier><identifier>DOI: 10.1016/j.jinf.2012.11.006</identifier><identifier>PMID: 23195031</identifier><identifier>CODEN: JINFD2</identifier><language>eng</language><publisher>Amsterdam: Elsevier Ltd</publisher><subject>Adolescent ; Adult ; Aged ; Anti-Bacterial Agents - administration & dosage ; Bacteria - classification ; Bacteria - drug effects ; Bacteria - isolation & purification ; Bacterial Infections - cerebrospinal fluid ; Bacterial Infections - drug therapy ; Bacterial Infections - microbiology ; Bacterial Infections - surgery ; Biological and medical sciences ; Cerebral Hemorrhage - surgery ; Cerebrospinal fluid shunts ; Cerebrospinal Fluid Shunts - adverse effects ; Female ; General aspects ; Humans ; Hydrocephalus ; Hydrocephalus - surgery ; Infectious Disease ; Infusions, Intraventricular ; Intraventricular antibiotic instillation ; Male ; Medical sciences ; Middle Aged ; Prosthesis-Related Infections - cerebrospinal fluid ; Prosthesis-Related Infections - drug therapy ; Prosthesis-Related Infections - microbiology ; Prosthesis-Related Infections - surgery ; Shunt infection ; Treatment Outcome ; Ventriculitis ; Ventriculoperitoneal Shunt - adverse effects ; Young Adult</subject><ispartof>The Journal of infection, 2013-03, Vol.66 (3), p.239-246</ispartof><rights>The British Infection Association</rights><rights>2012 The British Infection Association</rights><rights>2014 INIST-CNRS</rights><rights>Copyright © 2012 The British Infection Association. Published by Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-22daa448b4a034d590df907bf0b56ec2a604ad7d817552d5334a1267d941ba303</citedby><cites>FETCH-LOGICAL-c474t-22daa448b4a034d590df907bf0b56ec2a604ad7d817552d5334a1267d941ba303</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jinf.2012.11.006$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,45974</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=27054729$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23195031$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wilkie, M.D</creatorcontrib><creatorcontrib>Hanson, M.F</creatorcontrib><creatorcontrib>Statham, P.F</creatorcontrib><creatorcontrib>Brennan, P.M</creatorcontrib><title>Infections of cerebrospinal fluid diversion devices in adults: The role of intraventricular antimicrobial therapy</title><title>The Journal of infection</title><addtitle>J Infect</addtitle><description>Summary Objectives The precise role for intraventricular (IVT) antimicrobials in combination with systemic antibiotics in management of cerebrospinal fluid (CSF) diversion device-associated infections is uncertain. We evaluated our current practice, comparing dual therapy against systemic antimicrobials alone. Methods All adult patients with at least two consecutive CSF isolates who were treated for CSF diversion device-related infection over a 5-year period (2005–2010) were identified retrospectively. Clinical and laboratory parameters, microbiology, surgical and antimicrobial management, and treatment outcomes were analysed. Results Forty-eight patients were identified – 25 received IVT and systemic antibiotics (group A), and 23 systemic antibiotics alone (group B). Clinical features were similar between groups, as were causative organisms. CSF leucocyte counts differed slightly ( A > B , p = 0.067) but no laboratory parameters differed significantly. Infected devices were generally revised ( A = 92%, B = 91%). Mean times to CSF sterilisation and normalisation of CSF microscopy were significantly shorter for group A ( p < 0.05 and p < 0.005 respectively), as was duration of hospital stay ( p < 0.002) and required length of systemic antimicrobial therapy ( p < 0.001). Conclusions Our findings indicate that IVT antibiotics enhance clinical and microbiological recovery and should therefore be considered for patients with CSF infection associated with a CSF diversion device. We recommend further evaluation of this approach in a prospective, randomised, controlled trial.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Anti-Bacterial Agents - administration & dosage</subject><subject>Bacteria - classification</subject><subject>Bacteria - drug effects</subject><subject>Bacteria - isolation & purification</subject><subject>Bacterial Infections - cerebrospinal fluid</subject><subject>Bacterial Infections - drug therapy</subject><subject>Bacterial Infections - microbiology</subject><subject>Bacterial Infections - surgery</subject><subject>Biological and medical sciences</subject><subject>Cerebral Hemorrhage - surgery</subject><subject>Cerebrospinal fluid shunts</subject><subject>Cerebrospinal Fluid Shunts - adverse effects</subject><subject>Female</subject><subject>General aspects</subject><subject>Humans</subject><subject>Hydrocephalus</subject><subject>Hydrocephalus - surgery</subject><subject>Infectious Disease</subject><subject>Infusions, Intraventricular</subject><subject>Intraventricular antibiotic instillation</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Prosthesis-Related Infections - cerebrospinal fluid</subject><subject>Prosthesis-Related Infections - drug therapy</subject><subject>Prosthesis-Related Infections - microbiology</subject><subject>Prosthesis-Related Infections - surgery</subject><subject>Shunt infection</subject><subject>Treatment Outcome</subject><subject>Ventriculitis</subject><subject>Ventriculoperitoneal Shunt - adverse effects</subject><subject>Young Adult</subject><issn>0163-4453</issn><issn>1532-2742</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkk2LFDEQhhtR3HH1D3iQXAQv3Va-uqdFFmTxY2HBg-s5pJNqttqe9GzSPTD_3jQzKngQL8nleSupeqooXnKoOPD67VANFPpKABcV5xVA_ajYcC1FKRolHhebDMlSKS0vimcpDQDQyrZ-WlwIyVsNkm-Kh5vQo5tpColNPXMYsYtT2lOwI-vHhTzzdMCYMsE8HshhYhSY9cs4p3fs7h5ZnEZcwxTmaA-YT3LLaCOzYaYduTh1lKvN9xjt_vi8eNLbMeGL831ZfP_08e76S3n79fPN9Yfb0qlGzaUQ3lqltp2yIJXXLfi-habrodM1OmFrUNY3fssbrYXXUirLRd34VvHOSpCXxZtT3X2cHhZMs9lRcjiONuC0JMOlkE3bgvoPVGw1NHliOqPihOauUorYm32knY1Hw8GsVsxgVitmtWI4N9lKDr0611-6HfrfkV8aMvD6DNjk7NhHGxylP1wDWjWizdz7E4d5cAfCaJIjDA49xWzR-In-_Y-rv-JupED5xR94xDRMS8zac78mCQPm27o_6_pwAdkBKPkTKjjAWw</recordid><startdate>20130301</startdate><enddate>20130301</enddate><creator>Wilkie, M.D</creator><creator>Hanson, M.F</creator><creator>Statham, P.F</creator><creator>Brennan, P.M</creator><general>Elsevier Ltd</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7T7</scope><scope>7TK</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>P64</scope></search><sort><creationdate>20130301</creationdate><title>Infections of cerebrospinal fluid diversion devices in adults: The role of intraventricular antimicrobial therapy</title><author>Wilkie, M.D ; Hanson, M.F ; Statham, P.F ; Brennan, P.M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-22daa448b4a034d590df907bf0b56ec2a604ad7d817552d5334a1267d941ba303</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Anti-Bacterial Agents - administration & dosage</topic><topic>Bacteria - classification</topic><topic>Bacteria - drug effects</topic><topic>Bacteria - isolation & purification</topic><topic>Bacterial Infections - cerebrospinal fluid</topic><topic>Bacterial Infections - drug therapy</topic><topic>Bacterial Infections - microbiology</topic><topic>Bacterial Infections - surgery</topic><topic>Biological and medical sciences</topic><topic>Cerebral Hemorrhage - surgery</topic><topic>Cerebrospinal fluid shunts</topic><topic>Cerebrospinal Fluid Shunts - adverse effects</topic><topic>Female</topic><topic>General aspects</topic><topic>Humans</topic><topic>Hydrocephalus</topic><topic>Hydrocephalus - surgery</topic><topic>Infectious Disease</topic><topic>Infusions, Intraventricular</topic><topic>Intraventricular antibiotic instillation</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Prosthesis-Related Infections - cerebrospinal fluid</topic><topic>Prosthesis-Related Infections - drug therapy</topic><topic>Prosthesis-Related Infections - microbiology</topic><topic>Prosthesis-Related Infections - surgery</topic><topic>Shunt infection</topic><topic>Treatment Outcome</topic><topic>Ventriculitis</topic><topic>Ventriculoperitoneal Shunt - adverse effects</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wilkie, M.D</creatorcontrib><creatorcontrib>Hanson, M.F</creatorcontrib><creatorcontrib>Statham, P.F</creatorcontrib><creatorcontrib>Brennan, P.M</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Neurosciences Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><jtitle>The Journal of infection</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wilkie, M.D</au><au>Hanson, M.F</au><au>Statham, P.F</au><au>Brennan, P.M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Infections of cerebrospinal fluid diversion devices in adults: The role of intraventricular antimicrobial therapy</atitle><jtitle>The Journal of infection</jtitle><addtitle>J Infect</addtitle><date>2013-03-01</date><risdate>2013</risdate><volume>66</volume><issue>3</issue><spage>239</spage><epage>246</epage><pages>239-246</pages><issn>0163-4453</issn><eissn>1532-2742</eissn><coden>JINFD2</coden><abstract>Summary Objectives The precise role for intraventricular (IVT) antimicrobials in combination with systemic antibiotics in management of cerebrospinal fluid (CSF) diversion device-associated infections is uncertain. We evaluated our current practice, comparing dual therapy against systemic antimicrobials alone. Methods All adult patients with at least two consecutive CSF isolates who were treated for CSF diversion device-related infection over a 5-year period (2005–2010) were identified retrospectively. Clinical and laboratory parameters, microbiology, surgical and antimicrobial management, and treatment outcomes were analysed. Results Forty-eight patients were identified – 25 received IVT and systemic antibiotics (group A), and 23 systemic antibiotics alone (group B). Clinical features were similar between groups, as were causative organisms. CSF leucocyte counts differed slightly ( A > B , p = 0.067) but no laboratory parameters differed significantly. Infected devices were generally revised ( A = 92%, B = 91%). Mean times to CSF sterilisation and normalisation of CSF microscopy were significantly shorter for group A ( p < 0.05 and p < 0.005 respectively), as was duration of hospital stay ( p < 0.002) and required length of systemic antimicrobial therapy ( p < 0.001). Conclusions Our findings indicate that IVT antibiotics enhance clinical and microbiological recovery and should therefore be considered for patients with CSF infection associated with a CSF diversion device. We recommend further evaluation of this approach in a prospective, randomised, controlled trial.</abstract><cop>Amsterdam</cop><pub>Elsevier Ltd</pub><pmid>23195031</pmid><doi>10.1016/j.jinf.2012.11.006</doi><tpages>8</tpages></addata></record> |
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| subjects | Adolescent Adult Aged Anti-Bacterial Agents - administration & dosage Bacteria - classification Bacteria - drug effects Bacteria - isolation & purification Bacterial Infections - cerebrospinal fluid Bacterial Infections - drug therapy Bacterial Infections - microbiology Bacterial Infections - surgery Biological and medical sciences Cerebral Hemorrhage - surgery Cerebrospinal fluid shunts Cerebrospinal Fluid Shunts - adverse effects Female General aspects Humans Hydrocephalus Hydrocephalus - surgery Infectious Disease Infusions, Intraventricular Intraventricular antibiotic instillation Male Medical sciences Middle Aged Prosthesis-Related Infections - cerebrospinal fluid Prosthesis-Related Infections - drug therapy Prosthesis-Related Infections - microbiology Prosthesis-Related Infections - surgery Shunt infection Treatment Outcome Ventriculitis Ventriculoperitoneal Shunt - adverse effects Young Adult |
| title | Infections of cerebrospinal fluid diversion devices in adults: The role of intraventricular antimicrobial therapy |
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