Intra-thecal antibiotics for post-operative gram negative meningitis and ventriculitis.

Document Type



Neurosurgery; Surgery


BACKGROUND: Postoperative meningitis is a growing cause of concern especially with the evolution of multidrug resistant organism. OBJECTIVES: The authors evaluate the use of intraventricular/intrathecal antibiotics for postoperative Gramnegative meningitis in patients whom intravenous antibiotics were ineffective METHODS: Adult consecutive patients with cerebrospinal fluid (CSF) culture proven Gram-negative postoperative meningitis/ventriculitis, in which intravenous antibiotics were ineffective were included from January 2008- December 2012. RESULTS: From January 2008 to December 2012 there were 94 reported cases of post-operative meningitis/ventriculitis at our institution. Of these, 63 were culture proven Gram positive and were treated accordingly. Thirty one patients either had isolated Gram negative meningitis/ventriculitis or mixed Gram positive/negative, infection, of which 21 patients required treatment with IVT/IT antibiotics. Of these 21 patients, 16 were male and 5 were female. Mean age was 41.7 + 11 years (range 26 to 58 years). All except one of these patients had cranial surgery. Of the 21 patients in our study, 8 were admitted with a GCS of >12 while the remaining had a GCS < 12. Acinetobacter was the most common organism isolated on CSF culture (n=14) followed by Klebsiella (n=3), Pseudomonas (n=1) and Enterobacter (n=1). 1 patient had polymicrobial growth. Three antibiotics were used in the IVT/IT treatment group; Amikacin, Polymixin B and Colistin. The indication was primarily based on the sensitivity of pathogenic organisms cultured on CSF of individual patients; table 2 shows the resistance pattern of the organism. Amikacin was used in 7 patients, Polymixin B in 9 patients and Colistin in 5 patients. A combination of 2 IVT/IT antibiotics, Polymixin B and Amikacin was used in 1 patient. An EVD was used as the route of administration in 13 cases (62%) while a lumbar drain was used in 8 (38%) patients. Median duration between starting of IT/IVT after being diagnosed with post neurosurgical meningitis/ventriculitis was 3 days (Range 0-7days). Median duration of IVT/IT therapy was 15 (9-25) days. CSF sterility was achieved in all of the patients with a median time to sterility being 7.1 + 3.8 (Range 2-16) days (EVD 7.08 + 3.37 days vs. LD 7.1 + 4.6 days, p-value 0.176). Only two patients achieved CSF sterility within 48 hours. RESULTS: Discharge GCS improved in 2 remained the same in 7 and deteriorated in 12 patients. Median hospital stay was 38 days (20-257days) with the EVD group [46 (29-72)] having a longer stay than LD group [32.5 (20-76) days) p-value 0.07. At 6 months follow up favorable outcomes were seen in 14 (66.7%) patients and 7 (33.3%) patients remained in an unfavorable state. One patient died during treatment and although the patient had Acinetobacter species infection, the cause of death was found to be a massive pulmonary embolus. No adverse effects attributable to IVT/IT therapy were noted in the study. CONCLUSION: The findings of this study suggest that IVT antibiotic therapy is a useful option especially in patients who are non-responsive to standard intravenous therapy with little or no side effects. [ABSTRACT FROM AUTHOR] Copyright of Journal of Pioneering Medical Sciences is the property of Journal of Pioneering Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Publication (Name of Journal)

Journal of Pioneering Medical Sciences