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Treatment of Persistent Pyogenic Ventriculitis With Active Exchange of Cerebrospinal Fluid: A Report of 2 Cases
Kevin Gilotra1, Peter G Gerace1, Racheed Mani2
1Renaissance School of Medicine at Stony Brook University, Stony Brook , New York , USA.
Background And Importance:
Pyogenic ventriculitis is a rare, but fatal complication associated with community-acquired meningitis and invasive procedures. The blood-brain barrier poses a major challenge for systemic antibiotics to adequately treat infections confined to the ependyma of the ventricles.
Clinical Presentation:
In this case report, we demonstrate 2 cases of pyogenic ventriculitis that responded to active cerebrospinal fluid (CSF) exchange where continuous irrigation with antibiotics allowed for adequate CSF distribution. The first case is an 83-year-old man who acquired ventriculitis secondary to epidural injections for pain. The second case is that of a 60-year-old woman who developed ventriculitis as a complication of external ventricular drainage placement for left thalamic intracerebral hemorrhage with intraventricular extension.
Conclusion:
Although both patients had a complex medical history, inpatient complications, and initially failed to respond to systemic antibiotic therapy, their infections were cleared rapidly on initiation of active CSF exchange. Larger scale studies will be needed to demonstrate efficacy of this novel technique.
Insights
Active cerebrospinal fluid (CSF) exchange with continuous antibiotic irrigation effectively treated pyogenic ventriculitis in two complex cases. This novel approach offers a promising alternative when systemic antibiotics fail to clear ventricular infections.
Area of Science:
- Neuroscience
- Infectious Diseases
- Neurosurgery
Background:
- Pyogenic ventriculitis is a rare, life-threatening complication of meningitis and invasive procedures.
- The blood-brain barrier limits the efficacy of systemic antibiotics for ventricular infections.
Purpose of the Study:
- To report on the successful use of active cerebrospinal fluid (CSF) exchange for treating pyogenic ventriculitis.
- To highlight a novel therapeutic strategy for challenging central nervous system infections.
Main Methods:
- Two case reports of pyogenic ventriculitis are presented.
- Active CSF exchange with continuous antibiotic irrigation was employed.
Main Results:
- Both patients, despite complex medical histories and initial non-response to systemic antibiotics, achieved rapid infection clearance.
- The continuous irrigation facilitated adequate antibiotic distribution within the CSF.
Conclusions:
- Active CSF exchange is a potentially effective treatment for pyogenic ventriculitis.
- Further large-scale studies are required to validate this novel technique's efficacy.
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