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Intraventricular and Intravenous Tobramycin with Ceftazidime for Ventriculitis Secondary to Pseudomonas aeruginosa
Priscilla Masvosva1, Steven C Buckingham, Stephanie Einhaus
1University of Texas Medical Branch at Galveston, Galveston, Texas.
Abstract:
The preferred method for shunting cerebrospinal fluid in the ventricles is via a ventriculoperitoneal or ventriculoatrial shunt. Unfortunately, infection is a major complication of shunt surgery, which places the patient at risk of intellectual impairment and death. Although the most common causative pathogens are Staphylococcus epidermidis and Staphylococcus aureus, gram-negative bacterial infections have increased over the last three decades. Treatment of Pseudomonas ventriculitis is highly variable, because there are few guidelines for drug selection, administration, and monitoring. We report a case of post-shunt revision Pseudomonas meningitis/ ventriculitis that was successfully treated by the intraventricular adminstration tobramycin in conjunction with intravenous tobramycin and ceftazidime.
Insights
Shunt infection is a serious risk, with gram-negative bacteria like Pseudomonas increasingly causing ventriculitis. Intraventricular tobramycin combined with IV antibiotics successfully treated a challenging Pseudomonas ventriculitis case.
Area of Science:
- Neurosurgery
- Infectious Diseases
- Pharmacology
Background:
- Shunt surgery, commonly using ventriculoperitoneal or ventriculoatrial shunts, is essential for cerebrospinal fluid management.
- Infection is a significant complication, posing risks of intellectual impairment and mortality.
- While Staphylococcus species are common, gram-negative bacterial infections, particularly Pseudomonas, have risen in recent decades.
Observation:
- Treatment for Pseudomonas ventriculitis lacks standardized guidelines for drug selection, administration, and monitoring.
- A case of post-shunt revision meningitis/ventriculitis caused by Pseudomonas aeruginosa was observed.
Findings:
- Successful treatment was achieved through intraventricular administration of tobramycin.
- This was complemented by intravenous tobramycin and ceftazidime therapy.
- The combination therapy effectively addressed the gram-negative bacterial infection.
Implications:
- This case highlights a viable therapeutic strategy for complex Pseudomonas ventriculitis.
- Intraventricular antibiotic delivery may be crucial for eradicating infection in shunt-associated meningitis.
- Further research into optimized treatment protocols for gram-negative ventriculitis is warranted.
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