Antibiotic therapy for infected Ommaya reservoir systems

The major complication of prolonged use of a permanently implanted Ommaya reservoir system is bacterial infection, encountered in 3 to 15% of patients. The best therapeutic approach to ventriculitis and meningitis occurring in the presence of this device is still a subject of debate. We reviewed our experience in 66 consecutive patients receiving intraventricular therapy via the Ommaya reservoir for leptomeningeal metastases or for subacute sclerosing panencephalitis. Eight episodes of infection occurred during the period of treatment, and all of them responded to systemic antibiotics with or without intraventricular treatment. Removal of the Ommaya reservoir was avoided, and therapy via the device for the underlying disease was resumed as soon as the infection was controlled. No relapse of infection occurred during a minimal follow-up of 40 days. On the basis of our experience and review of the literature, we challenge the concept that the Ommaya device, as a foreign body, must be removed to treat such infections successfully.