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Serial cytokine profiles in shunt-related ventriculitis treated with intraventricular vancomycin
Gary Laborada1, Florencia Cruz, Mirjana Nesin
1Weill Medical College of Cornell University, New York, NY, USA.
Insights
Intraventricular vancomycin successfully treated methicillin-resistant Staphylococcus aureus ventriculitis in an infant when standard therapy failed. Cerebrospinal fluid sterilization correlated with reduced white blood cells and inflammatory cytokines.
Area of Science:
- Pediatric Infectious Diseases
- Neurocritical Care
- Antimicrobial Therapy
Background:
- A premature infant presented with persistent shunt-related methicillin-resistant Staphylococcus aureus (MRSA) ventriculitis.
- Parenteral vancomycin and gentamicin/rifampin therapy were ineffective against the infection.
Observation:
- Treatment involved intraventricular vancomycin administration for 5 days.
- Cerebrospinal fluid (CSF) analysis included standard testing and serial measurement of inflammatory cytokines (TNF-α, IL-8, IL-6).
Findings:
- Intraventricular vancomycin led to CSF sterilization.
- A decrease in white blood cell count and proinflammatory cytokines was observed post-treatment.
Implications:
- Intraventricular antibiotic administration is a viable option for refractory ventriculitis.
- Serial cytokine monitoring in CSF can aid in assessing therapeutic response.
Background:
A 1-month-old premature infant developed persistent shunt-related methicillin-resistant Staphylococcus aureus ventriculitis that was not responsive to parenteral therapy with vancomycin plus gentamicin (or rifampin).
Methods:
The infant was treated by intraventricular administration of vancomycin (5 days: 10 mg/day). In addition to standard testing of the cerebrospinal fluid (CSF), tumor necrosis factor alpha, interleukin-8 and interleukin-6 were serially measured.
Results:
Sterilization of the CSF was followed by a decline in the number of WBC and proinflammatory cytokines in the CSF.
Conclusion:
Intraventricular administration of antibiotics may be considered if ventriculitis is refractory to systemic antimicrobial therapy. Serial measurements of inflammatory cytokines in the CSF may provide an additional diagnostic tool to monitor the outcome of therapy.
