Persistent and intractable ventriculitis due to retained ventricular catheters

It is generally recommended that, in cases of difficulty in removing a ventricular catheter during a shunt revision, it is best left alone to avoid intraventricular haemorrhage. Retained ventricular catheters (RVCs) are usually safe, although in the presence of ventriculitis they may become colonized by organisms and become a source of persistent or recurrent infection. The authors present a case of persistent and intractable ventriculitis due to an old retained ventricular catheter. A 23-year-old female, who had a RVC and a functioning shunt, was admitted for a suspected blocked shunt. At surgery the shunt was found to be infected and external drainage was instituted. Over the next 4 months, she developed intractable and persistent staphylococcal ventriculitis, despite undergoing 10 further surgical procedures, and appropriate intravenous and intrathecal antibiotic therapy. She responded rapidly only after surgical removal of the old RVC via a craniotomy. The staphylococcus cultured from the RVC had an identical antibiogram to the organism responsible for the intractable ventriculitis. This case emphasizes the point that, although RVC are generally considered safe, removal becomes imperative in the presence of concurrent CSF infection that fails to respond quickly to intrathecal antibiotic therapy.