Infections of cerebrospinal fluid diversion devices in adults: The role of intraventricular antimicrobial therapy

Abstract

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. 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. 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). 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.