Intraventricular Research Articles

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

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. 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. 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. 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 12.2mg/day for a median duration of 5days. 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 6.7mg/day with a median duration of 6days. 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%. 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.

The Role of Intraventricular Antibiotics in the Treatment of Nosocomial Ventriculitis/Meningitis from Gram-Negative Pathogens: A Systematic Review and Meta-Analysis

The emergence of multidrug-resistant pathogens has resulted in difficult-to-treat ventriculitis/meningitis (VM). We used a meta-analysis to study the role of intraventricular (IVT) antibiotic administration as an adjunct (IVT plus intravenous [IV]) to the classic intravenous antimicrobial therapy (IV-only) in the management of VM in terms of infection control, functional outcome, microbial eradication, complications, cost-benefit analysis, infectious mortality, and overall mortality. The electronic search focused on adult neurosurgical cases complicated by gram-negative VM and was limited to studies comparing IVT plus IV and IV-only. The quality of the overall body of evidence was assessed according to GRADE (Grading of Recommendations Assessment, Development, and Evaluation). The pooled estimates for each question were summarized as odds ratios (ORs) and visualized using forest plots. Every outcome was stratified according to carbapenem resistance. Eleven studies with 348 patients fulfilled the eligibility criteria. No evidence was found for infection control, functional outcome, or complications. For the remaining items evaluated, the overall quality of the best available evidence was low. IVT plus IV treatment was statistically superior to IV-only therapy in eradication (OR, 10.06; 95% confidence interval [CI], 2.62-38.65), infectious mortality (OR, 0.1; 95% CI, 0.03-0.36), and overall mortality (OR, 0.22; 95% CI, 0.08-0.60) in the management of carbapenem-resistant pathogens only. Combined IVT plus IV treatment did not prove superior to standard IV-only treatment in the management of VM. Nevertheless, weak evidence showed that IVT treatment might serve as an adjunct in the management of carbapenem-resistant pathogens.

Role of Neuroendoscopy in Management of Intraventricular Lesions

Objective: Intraventricular (IV) lesions are easily being approached with the endoscope through the ventricular system, because intraventricular tumors often cause cerebrospinal fluid (CSF) pathway obstruction and hydrocephalus. The aims of endoscopy in intraventricular tumors are usually the restoration of CSF pathway obstruction, clarification of the histology, and if possible, a complete tumor removal. Methods: Twenty five consecutive cases with IV lesions were removed or biopsied with or without ETV and septum pellucidostomy. Patient information was retrospective entered into a database. Outcomes were evaluated by life table analysis. Results: Twenty five patients had completed with ETV in 16 cases; six cases by cyst fenestration, seven cases tumor biopsy 10 cases cyst removal, two cases hematoma were evacuated. 16 cases improved post-operative (clinical and radiological), three cases needed VP shunt, Three cases with same clinical as pre-operative, One case presented with paresis, Two cases operated microscopically after one year. Conclusions: The advantages of the endoscopic approach are minimal dissection and brain retraction. Reach to the target is rapid. The method of choice for removal of colloid cysts, arachnoid cysts and restore CSF pass way obstructed by lesions at the same operation.

Atrioventricular and intraventricular block after transcatheter aortic valve implantation.

Aortic stenosis is the most common valvular heart disease in industrialized countries and the most common cause of left ventricular outflow tract (LVOT) obstruction. Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement for intermediate to high-risk surgical candidates with symptomatic severe aortic stenosis. Conduction system abnormalities, including atrioventricular (AV) and intraventricular (IV) block, are the most common complication of TAVR. In this review, we aim to explore the anatomical issues relevant to atrioventricular block, the relevant clinical and procedural aspects, and the management and long-term implications of AV and IV block.

Outcomes of adjunctive therapy with intrathecal or intraventricular administration of colistin for post-neurosurgical meningitis and ventriculitis due to carbapenem-resistant acinetobacter baumannii

The efficacy and safety of intrathecal (ITH) or intraventricular (IVT) colistin in addition to intravenous (IV) colistin for meningitis and ventriculitis due to carbapenem-resistant Acinetobacter baumannii (CRAB) is unclear. In this retrospective observational study of 40 patients with post-neurosurgical meningitis and ventriculitis due to CRAB, 33 patients without concomitant infection received appropriate dosage regimens of IV colistin. Of the 33 patients, 17 received additional ITH/IVT colistin and 16 received only IV colistin. The 14-day, 30-day and in-hospital mortality rates were nominally lower for patients who received ITH/IVT colistin adjunctive therapy versus patients who received only IV colistin (24% vs. 38%, 29% vs. 56% and 29% vs. 56%, respectively). The costs of treatment were significantly lower, the lengths of hospital and intensive care unit (ICU) stay were significantly shorter, and the number of ventilator days was significantly less among patients who received ITH/IVT colistin compared with patients who did not receive ITH/IVT colistin. The initial Acute Physiology and Chronic Health Evaluation (APACHE) II and Glasgow Coma Scale (GCS) scores were associated with 30-day mortality with odds ratios (95% confidence intervals) of 1.21 (1.08–1.46) and 0.77 (0.44–0.85), respectively. Chemical meningitis from ITH/IVT colistin was mild and resolved spontaneously. Treatment of post-neurosurgical CRAB meningitis and ventriculitis with ITH/IVT colistin as an adjunct to IV colistin was associated with shorter lengths of hospital and ICU stay and a trend to lower mortality, especially among severely ill patients.

Management of Intracranial Ventriculitis caused by Multidrug Resistant Acinetobacter Baumannii: Case Report and Literature Review

Background: We report a case of a male patient in our hospital who developed associated multidrug-resistant Acinetobacter baumanii (MDRAB) intracrainial ventriculitis and treated using intraventricular (IVT) plus intrathecal (IT) colistin.
 Objective: The purpose of our case report is to show case the effectiveness and safety of using intraventricular (IVT) plus intrathecal(IT) colistin in the management of potentially fatal MDRAB associated intracrainial ventriculitis.
 Materials and methods: Patient was diagnosed with MDRAB after developing associated symptoms and conducting cerebral spinal fluid (CSF) culture and sensitivity analysis. Colistin 250,000 IU once daily administered via intraventricular plus intrathecal routes for 14 days was prescribed.
 Result: Cerebrospinal fluid was collected on the 14th day post commencement of colistin and sterilization was attained.
 Conclusion: Colistin is a potentially effective and safe therapy for the treatment of MDRAB intracrainial ventriculitis.

Management of intracranial ventriculitis caused by multidrug resistant Acinetobacter baumannii : case report and literature review

Background: We report a case of a male patient in our hospital who developed associated multidrug-resistant Acinetobacter baumanii (MDRAB) intracrainial ventriculitis and treated using intraventricular (IVT)plus intrathecal(IT) colistin. Objective: The purpose of our case report is to show case the effectiveness and safety of using intraventricular (IVT) plus intrathecal(IT) colistin in the management of potentially fatal MDRAB associated intracrainial ventriculitis. Materials and methods: Patient was diagnosed with MDRAB after developing associated symptoms and conducting cerebral spinal fluid(CSF) culture and sensitivity analysis. Colistin 250,000 IU once daily administered via intraventricular plus intrathecal routes for 14 days was prescribed. Result: Cerebrospinal fluid was collected on the 14th day post commencement of colistin and sterilization was attained. Conclusion: Colistin is a potentially effective and safe therapy for the treatment of MDRAB intracrainial ventriculitis. Keywords: Acinetobacter baumannii , colistin, ventriculitis, intraventricular, intrathecal

P10042D and 3D-echo in LV intraventricular dyssynchrony assessement, and factors related to its severity

P10042D and 3D-echo in LV intraventricular dyssynchrony assessement, and factors related to its severity

Systematic Review of Efficacy, Pharmacokinetics, and Administration of Intraventricular Aminoglycosides in Adults.

Due to increasing prevalence of intracranial device use and multidrug-resistant and nosocomial organisms, central nervous system (CNS) infections requiring treatment with intraventricular (IVT) aminoglycosides are becoming increasingly common. This article systematically reviews IVT aminoglycoside literature in adults and integrates available evidence to serve as a practical reference for clinicians. Medline (1946 to December 2015), Embase (1974 to December 2015), PubMed (1966 to December 2015), Google, and Google Scholar were searched using the term aminoglycoside combined individually with the terms IVT, meningitis, shunt infection, ventriculitis, and cerebral spinal fluid. Eighteen articles were included. IVT aminoglycosides were assessed in meningitis, ventriculitis, intracranial device infections and neurosurgery prophylaxis. No serious adverse effects following IVT aminoglycoside were reported. Dosages ranged from IVT gentamicin 4-10mg daily, IVT tobramycin 5-10mg daily, and IVT amikacin 5-50mg daily. Duration of therapy should be individualized; however, continuing IVT antibiotics for 3days and up to 21days after cerebrospinal fluid (CSF) sterilization has been reported in literature. Most studies included concomitant intravenous antibiotic use. Therapeutic drug monitoring (TDM) was reported in five studies, with varying timing of CSF concentrations obtained. No clear relationship between CSF levels and efficacy or toxicity was evident. Based on current literature, IVT aminoglycosides for the treatment of sensitive gram-negative meningitis, ventriculitis, and CNS device-associated infections appear safe and effective. Optimal dosing regimens are unclear. It is reasonable to initiate IVT aminoglycoside at lowest dose in combination with IV therapy and continuing post CSF sterilization. Preservative-free formulations should be utilized to minimize adverse drug reactions. TDM should not be routinely utilized but reserved for more complicated patients. Further pharmacokinetic and clinical trials of IVT aminoglycosides are necessary to fill current therapeutic gaps. Due to the relatively limited cases of IVT aminoglycoside utilization, prospective, randomized, controlled trials are likely not feasible, and clinicians will have to rely on data from non-randomized and/or retrospective studies.

Biventricular Mural Endocarditis on the Intraventricular Septum

Mural endocarditis is an inflammation and disruption of the nonvalvular endocardial surface of the cardiac chambers. We present a rare case of mural endocarditis on the intraventricular (IV) septum on both the left and right ventricular side with intact valvular annulus. This case highlights the complexity of the operative and postoperative management in an unprecedented case of biventricular mural endocarditis.

The Effect of Intraventricular Administration of Zinc on Serum LH, FSH, Prolactin, and Testosterone in Male Rats

Background: Zn is calcium channels blocker and interferes with biological function of calcium ion, and FSH and LH secretion are dependent on calcium ion. Objectives: The aim of this study was evaluate the effects of supra physiological dose of zinc injection in lateral ventricle (LV) on serum FSH, LH, testosterone, and prolactin (PRL) in male rats. Materials and Methods: This experiment was performed on 30 Wistar-Albino male rats weighing 220 - 260 g, which were cannulated in LV. Rats were divided into: sham control (SC), control (V), and test (T) groups, randomly. Test group received 10 µL of artificial cerebra spinal fluid (ACSF) containing 0.06 μmol zinc sulfate, for 20 days. Group V was given the same volume of ACSF, but group SC did not receive any agent at this time. At the end, animals were anesthetized by diethyl ether, sacrificed and blood samples were collected. Serum gonadotropins and prolactin were measured via rat kits and ELISA methods. Testosterone was measured by ordinary methods. Obtained data were analyzed by SPSS-17 software and Kruskal-Wallis, Mann-Whitney and Bonnferoni correction statistical tests. Results were expressed as mean ± SD. Statistical differences were recognized significant at P < 0.05. Results: Our findings showed that serum LH, food and weight gain in group T significantly decreased but prolactin value in this group increased in comparison to those in other groups. Conclusions: We conclude that intraventricular (IV) injection of supra physiological dose of zinc sulfate in IV affected on serum LH, prolactin, food intake, and gain of weight in male rats.

Ранняя неинвазивная диагностика ишемической болезни сердца у пациента с метаболическим синдромом, морбидным ожирением и сопутствующими нарушениями внутрижелудочкового проведения

Ранняя неинвазивная диагностика ишемической болезни сердца у пациента с метаболическим синдромом, морбидным ожирением и сопутствующими нарушениями внутрижелудочкового проведения

Adjunctive intraventricular antibiotic therapy for bacterial central nervous system infections in critically ill patients with traumatic brain injury.

Limited data exist on the role of adjunctive intraventricular (IVT) antibiotics for the treatment of central nervous system (CNS) infections in traumatic brain injury (TBI) patients. To evaluate differences in CNS infection cure rates for TBI patients who received adjunctive IVT antibiotics compared with intravenous (IV) antibiotics alone. We retrospectively identified patients with TBI and bacterial CNS infections admitted to the trauma intensive care unit (ICU) from 1997 to 2013. Study patients received IV and IVT antibiotics, and control patients received IV antibiotics alone. Clinical and microbiological cure rates were determined from patient records, in addition to ICU and hospital lengths of stay (LOSs), ventilator days, and hospital mortality. A total of 83 patients were enrolled (32 study and 51 control). The duration of IV antibiotics was similar in both groups (10 vs 12 days, P = 0.14), and the study group received IVT antibiotics for a median of 9 days. Microbiological cure rates were 84% and 82% in study and control groups, respectively (P = 0.95). Clinical cure rates were similar at all time points. No significant differences were seen in days of mechanical ventilation, ICU or hospital LOS, or hospital mortality. When only patients with external ventricular drains were compared, cure rates remained similar between groups. TBI patients with CNS infections had similar microbiological and clinical cure rates whether they were treated with adjunctive IVT antibiotics or IV antibiotics alone. Shorter than recommended durations of antibiotic therapy still resulted in acceptable cure rates and similar clinically relevant outcomes.

Intraventricular Nicardipine for Reversible Vasospasm Related to Cryptococcal Meningovasculitis

Basilar meningovasculitis causing diffuse vasospasm is an under recognized complication of CNS cryptococcal infection. We report the case of cryptococcal meningitis causing severe vasospasm and its successful treatment with intraventricular (IVT) nicardipine.

OP27 * ETOPOSIDE PHARMACOKINETICS FOLLOWING INTRA-CEREBROSPINAL FLUID ADMINISTRATION IN PATIENTS WITH LEPTOMENINGEAL METASTASES

INTRODUCTION: Daily intra-cerebrospinal fluid (CSF) etoposide administration regimens are in use, by-passing the blood-brain-barrier and offering higher CSF drug concentrations at 1/30th to 1/340th the dose in conventional systemically administered standard and high dose etoposide regimens, respectively. METHOD: 42 pharmacokinetic samples were obtained from a paediatric (36) and adult patient (6). Etoposide 0.75 mg was administered over 1-2 minutes via the intra-ventricular (IVT) or lumbar route (LR), on 5 consecutive days for 1-3 weeks. CSF sampling at 4h (IVT: 3, LR: 3), 8h (IVT: 3, LR: 2), 18h (IVT: 1, LR: 1), 24h (IVT: 11, LR: 9), and 72h (IVT: 5, LR: 4). Etoposide concentrations were determined by LC/MS analysis, with a detection limit of 0.1 µg/ml. RESULTS: No acute neurotoxicity was observed. Single IVT administration with LR sampling yielded higher concentrations than LR administration with IVT sampling at 4h and 8h (1.73 and 0.93 µg/ml, vs. 1.42 and 0.76 µg/ml, respectively), also observed with simultaneous LR and IVT administration (median LR concentration 5.11 and 1.77 µg/ml at 4h and 8h; median IVT concentration 3.64 and 1.48 µg/ml at 4h and 8h). Concentrations at 24h were <0.2 (median 0.15, 14 samples) and at 72h <0.1 µg/ml (8 samples), irrespective of routes and sample sites. CONCLUSION: Intra-CSF etoposide administration at this dose level is safe, with almost complete clearence at 24h, and good distribution throughout the CSF compartment, irrespective of delivery route. Higher LR compared to IVT concentrations are probably related to CSF stasis. The rapid clearance characteristic warrants investigation of continuous drug infusion to sustain targeted CSF steady state etoposide concentrations.

Quantitative analysis of intraventricular blood flow dynamics by echocardiographic particle image velocimetry in patients with acute myocardial infarction at different stages of left ventricular dysfunction.

Left ventricular (LV) diastolic filling is characterized by the formation of a vortex that supports an efficient transit into systolic ejection. Aim of this study was to assess the intraventricular (IV) blood flow dynamics among patients with ST elevated myocardial infarction (STEMI) at different degrees of LV dysfunction, in the attempt to find novel indicators of LV pump efficiency. Sixty-four subjects, 34 consecutive STEMI patients and 30 healthy controls, underwent before hospital discharge 2D speckle tracking echocardiography to assess global longitudinal strain (GLS), and echo-particle image velocimetry analysis to assess flow energetic parameters. Left ventricular volumes ejection fraction (LVEF) and global wall motion score index (GWMSI) were evaluated by 3D echocardiography. ST elevated myocardial infarction patients were subdivided into three groups according to LVEF. Energy dissipation, vorticity fluctuation, and kinetic energy fluctuation indexes, which characterize the degree of disturbance in the flow, exhibit a biphasic behaviour in STEMI patients when compared with controls, with the highest values in patients with still preserved LV function and progressive lower values with LV function worsening. Significant linear correlations were found between energy dissipation index and both LVEF and GLS (r = 0.57, P < 0.001 and r = -0.61, P = 0.001, respectively). Kinetic energy fluctuation index significantly correlates with both LVEF (r = 0.75, P < 0.001) and GLS (-0.58, P = 0.002). Finally, a significant correlation was observed between GWMSI and energy dissipation index (-0.56, P = 0.008). The present study describes, for the first time, the progression of IV flow energetic properties in patients with acute myocardial infarction at different stages of LV dysfunction when compared with healthy controls. Further data are needed to assess the role of these parameters in the development and maintenance of LV dysfunction.

Electrocardiography in 110 patients with systemic sclerosis: a cross-sectional comparison with population-based controls

Objectives: Patchy fibrosis of the myocardium is thought to cause conduction abnormalities in patients with systemic sclerosis (SSc). We compared the prevalence and type of rhythm/conduction disturbances in 74% of the SSc patients in Stockholm County and controls.Method: A total of 110 SSc patients (age 62 ± 12 years) fulfilling the American College of Rheumatology (ACR) criteria for SSc and 105 gender- and age-matched controls participated in this study. A 12-lead resting electrocardiogram (ECG) was performed in all participants. The first 49 patients and 42 controls also underwent a 22–24-h Holter ECG recording. Associations with disease subsets, autoantibodies, cardiovascular risk factors, and left ventricular ejection fraction (LVEF), as estimated by echocardiography, were investigated.Results: Abnormal ECGs were found in 28% of patients and 17% of controls (p = 0.05). Atrioventricular (AV) and/or intraventricular (IV) conduction abnormalities were found in 15% of patients and 5% of controls (p < 0.01). Four patients, but no controls, had low anteroseptal R-wave/septal Q-wave patterns with narrow QRS complexes, simulating a septal wall infarction pattern. Patients had more abnormal Holter ECG recordings than controls (38% vs. 17%, p = 0.05). All participants with a normal resting ECG had an LVEF ≥ 50%.Conclusions: Although ECGs are inexpensive, commonly available screening tools, to detect arrhythmias, such as frequent ventricular extrasystoles (VES), Holter tracings should be performed. The frequencies of AV and/or IV conduction abnormalities and septal Q waves/low R waves have not changed since 1985. The unmet need of anti-fibrotic treatment in SSc is underscored by these findings.

Successfull Treatment of Ventriculitis Caused by Extensively Drug Resistant (XDR) Acinetobacter Baumannii with Intraventriculer Colistin Administration: Report of Two Cases

Acinetobacter baumanni, is an important nosocomial infection pathogen has emerged worldwide and can causes life-threatening hospital acquired infections, particularly in intensive care units. After post neurosurgical operations or procedures, this pathogen consists with central nervous system infections, also. Resistance mechanism of these pathogens against broad-spectrum antimicrobials is the challenging problem and limited penetration of antibiotics to achieve therapeutic concentrations in cerebrospinal fluid (CSF) has been still controversial issue. Here we report two cases who had ventriculitis after external ventricular drainage placement procedures. Both of CSF of two cases yielded extensively drug resistant A. baumannii. Traditional intravenous (IV) treatment did not eradicate pathogen exactly, at first. Adjunctive colistimetat sodium every 12 h (10 mg/kg/day) by the route of intraventricular (IVT) was admitted and CSF sterilization was achieved thereafter. The option of IVT colistin administration must be considered with IV antibiotherapy to provide satisfactory treatment of those complicated CNS infections.

Abnormal ECG Findings In Turkish Adults: An Epidemiologic Observational Study

Objective: Atherosclerotic cardiovascular disease (CVD) is the leading cause of death worldwide. Abnormal electrocardiography (ECG) findings are predictors of short-term cardiovascular risk. We aimed to contribute lacking national epidemiologic data regarding the prevalence of abnormal ECG findings in Turkish adults. Methods: The prevalence of abnormal ECG findings and arrhythmias were investigated in the west Black sea region of Turkey. A total of 2239 subjects over 18 years old were examined with 12 derivation resting ECG in this large epidemiological observational cohort study. Pathological Q waves, axis deviation, high R amplitude, ST-T changes, atrioventricular (AV) blocks, intraventricular (IV) blocks, arrhythmias and low QRS voltage were interpreted as ECG parameters. ECG findings were classified according to the Minnesota coding system. Results: Mean age was 50 ± 15 (age=18 to 92) years. Age-adjusted (over 40 years old) prevalence of abnormal ECG findings and arrhythmias were detailed in the following respectively; pathological Q waves 2.06%, left axis deviation 9.64%, high R wave amplitude 6.57%, ST segment depression 2.01%, T inversion 3.25%, left bundle branch block (LBBB) 2.63%, extra systoles 3.26% and atrial fibrillation 2.01%. Conclusion: This observation reveals the increasing trend of the prevalence of arterial hypertension, coronary artery disease (CAD) and atrial fibrillation in the last two decades in Turkey.

Intraventricular and lumbar intrathecal administration of antibiotics in postneurosurgical patients with meningitis and/or ventriculitis in a serious clinical state

To date, reports on the clinical efficacy of intraventricularly and intrathecally administered antibiotics for the treatment of neurosurgical ventriculitis and meningitis in adults are limited. The authors aimed to evaluate the efficacy and safety of the intraventricular (IVT) and lumbar intrathecal (IT) administration of antibiotics in critically ill neurosurgical patients. Thirty-four postneurosurgical patients with meningitis and ventriculitis were studied. Intraventricular/lumbar intrathecal antibiotics were administered due to positive CSF cultures persisting despite the use of intravenous antibiotics. The time period until CSF sterilization, changes in clinical state, and efficacy of different routes of antibiotic administration were evaluated. The mean time necessary to obtain CSF sterilization was 2.9 ± 2.7 days (range 1-12 days). The CSF cultures became negative within 24 hours after the administration of IVT/IT antibiotics in 17 patients (50%) and up to 48 hours in a further 6 patients (18%). The clinical outcome of patients assessed by the modified Rankin Scale improved in 17 patients (50%), stayed unchanged in 10 patients (29%), and was impaired in 1 patient (3%). Six patients (18%) died; however, 2 of them died due to reasons not directly related to meningitis or ventriculitis, so the overall mortality rate for meningitis and/or ventriculitis was 11.8% in this group of patients. All patients with ventriculitis (n = 4) were treated by antibiotics administered via the IVT route. The average time to CSF sterilization was 6.5 days in the patients with ventriculitis. Thirty patients had clinical signs of meningitis without ventriculitis. Despite the higher ratio of unfavorable Gram-negative meningitis in the subgroup of patients treated via lumbar drainage, the mean duration of CSF sterilization was 2.2 days compared with 2.6 days in the subgroup treated via external ventricular drainage, a difference that was not statistically significant (p = 0.3). Adverse effects of IVT/IT antibiotics appeared in 3 of 34 patients and were of low clinical significance. Intraventricular/lumbar intrathecal antibiotics can lead to very quick CSF sterilization in postneurosurgical patients with meningitis and ventriculitis. The relapse rate of meningitis and/or ventriculitis is also very low among patients treated by IVT/IT antibiotics. Intraventricular/lumbar intrathecal administration of antibiotics appears to be an effective and safe treatment for infections of the CNS caused by multidrug-resistant organisms. In patients with signs of ventriculitis, the authors prefer the IVT route of antibiotics. This study did not prove a lower efficacy of administration of antibiotics via lumbar drainage compared with the ventricular route in patients with meningitis.