Diagnosis and treatment of pyogenic ventriculitis caused by gram-negative bacteria in severe neurosurgical patients

Abstract

Objective To investigate the experiences in diagnosis and treatment pyogenic ventriculitis caused by gram-negative bacteria (G-) in severe neurosurgical patients. Methods Nineteen consecutive patients with pyogenic ventriculitis treated at the Neurosurgical Intensive Care Unit of the Department of Neurosurgery, Beijing Xuanwu Hospital, Capital Medical University from September 2009 to August 2014 were reviewed. Their bacteriological results, clinical treatment, and prognosis were analyzed. Results Ventricular drainage of cerebrospinal fluid bacterial smears in all cases were G-bacteria. Head CT scans confirmed as intraventricular empyema. Eighteen patients were positive in cerebrospinal fluid bacterial culture, 12 of them were Acinetobacter baumannii, 2 were Klebsiella pneumonia, 2 were Serratia marcescens, 1 was Pseudomonas maltophila, and 1 was Escherichia coli. The bacterial culture in one case was negative. The catheters which caused infections were removed and ventricular drainage was conducted in all cases. The patients were treated with intraventricular lavage in combination with intravenous drugs and intraventricular antibiotics according to the conditions. They were followed up for 3 months to 3 years. After treatment for 2 to 8 weeks, 14 patients were cured (74%) and 5 died (26%). In the cured patients, 8 patients underwent ventriculo-peritoneal shunt after the infection being cured in 2 to 6 weeks because of hydrocephalus. No reinfection occurred. Twelve patients came to consciousness, and 2 were in a persistent vegetative state before infection and did not have any improvement. Conclusions Suppurative ventriculitis in severe neurosurgical patients is mainly caused by G-negative bacteria. The mortality is higher. Early diagnosis, especially clarifying pathogens, timely ventricular irrigation, and ventricular drainage in combination with intravenous and intraventricular antibiotic treatment may increase the cure rate and improve the prognosis. Key words: Cerebral ventriculitis; Gram-negative bacteria; Intensive care unit; Acinetobacter baumannii