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Persistent and intractable ventriculitis due to retained ventricular catheters.
G V Vajramani1, G Jones, R Bayston
1Department of Neurosurgery, Southampton General Hospital, UK.
British Journal of Neurosurgery
|April 1, 2006
Summary
Retained ventricular catheters are usually safe but can cause persistent infections. This case highlights that removing these catheters is crucial for treating intractable cerebrospinal fluid infections unresponsive to antibiotics.
Area of Science:
- Neurosurgery
- Infectious Diseases
- Medical Device Management
Background:
- Retained ventricular catheters (RVCs) are often left in situ during shunt revisions to prevent intraventricular hemorrhage.
- While generally safe, RVCs can become a nidus for persistent or recurrent infections, particularly ventriculitis.
Observation:
- A 23-year-old female with a retained ventricular catheter and functioning shunt presented with shunt obstruction.
- The shunt was found to be infected, leading to external drainage.
- Despite multiple surgical interventions and antibiotic treatments over 4 months, the patient developed intractable staphylococcal ventriculitis.
Findings:
- Surgical removal of the old retained ventricular catheter via craniotomy led to a rapid clinical response.
- The Staphylococcus strain isolated from the RVC demonstrated identical antibiotic resistance patterns to the organism causing the ventriculitis.
Implications:
- This case underscores that retained ventricular catheters, while typically safe, necessitate removal when associated with persistent cerebrospinal fluid infections.
- Prompt catheter removal is imperative in cases of refractory ventriculitis to achieve successful treatment and prevent complications.