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Published on: March 31, 2022
Prevention of Ommaya Reservoir-Associated Bacterial Meningitis With Prophylactic Intraventricular Vancomycin
Mara Trifoi1, Kyle Tuohy1, Krishana Sichinga1
1Department of Neurosurgery, Penn State Hershey Medical Center, Hershey , Pennsylvania , USA.
Background And Objectives:
Intraventricular chemotherapy administered through an Ommaya reservoir (OmR) constitutes an integral part of therapy for patients with leptomeningeal metastasis. Unfortunately, OmR infections remain a frequent, costly, morbid, and occasionally fatal complication, limiting the benefit of this approach. We evaluate the efficacy, cost savings, and toxicity of vancomycin coadministered with intraventricular chemotherapy for the prevention of OmR-associated bacterial meningitis.
Methods:
This was a cohort study comparing a treatment group treated from May 1, 2021, to April 30, 2022, and a retrospective control group treated from 2016 to 2021. Patients were included if they had a diagnosis of leptomeningeal metastasis and subsequent placement of an OmR, followed by delivery of planned intraventricular chemotherapy. Patients in the treatment group received a 10-mg dose of intraventricular vancomycin in addition to their standard chemotherapy regimen at each treatment. We compared this group to a retrospective cohort from the preceding 5 years who did not receive intraventricular vancomycin, evaluating the rate of infection, adverse events, and associated treatment costs between groups.
Results:
The infection rate was 0% (95% CI 0%-6.75%) among the 63 patients and 0% (0%-0.76%) in the 501 consecutive treatments administered over the 12-month study period, compared with 10.25% (7.39%-14.0%) among the 322 patients and 1.71% (1.22%-2.39%) in 1932 treatments over the preceding 5 years. The absolute risk reduction was 10.3% (3.83-14.04), P = .0028. The number needed to treat was 10 (7-26). Cost per vancomycin dose was $10.00 ($5010 over 12 months). The cost of nonsurgical treatment of 1 OmR-associated infection is $88 372, which translates into $618 604 for the estimated 7 patients over 12 months who developed an OmR-associated infection. No treatment-associated toxicity was observed.
Conclusion:
Prophylactic intraventricular vancomycin eliminated OmR-associated infections without added toxicity and with dramatic cost savings.
Insights
Prophylactic intraventricular vancomycin effectively prevented Ommaya reservoir infections in patients with leptomeningeal metastasis. This approach eliminated infections, reduced costs, and showed no added toxicity.
Area of Science:
- Neuro-oncology
- Infectious Diseases
- Pharmacology
Background:
- Ommaya reservoirs (OmR) are crucial for intraventricular chemotherapy in leptomeningeal metastasis.
- OmR infections are a significant complication, increasing morbidity and mortality.
- Preventing OmR infections is vital to maximize therapeutic benefits.
Purpose of the Study:
- To evaluate the efficacy of vancomycin coadministered with intraventricular chemotherapy for OmR infection prevention.
- To assess the cost savings associated with prophylactic intraventricular vancomycin.
- To determine the toxicity profile of this preventive strategy.
Main Methods:
- A cohort study comparing a vancomycin treatment group (May 2021-April 2022) with a retrospective control group (2016-2021).
- Patients with leptomeningeal metastasis and OmR placement receiving intraventricular chemotherapy were included.
- Infection rates, adverse events, and treatment costs were compared between groups.
Main Results:
- The infection rate was 0% in the vancomycin group versus 10.25% in the control group (P = .0028).
- The number needed to treat was 10, indicating high efficacy.
- Prophylactic vancomycin resulted in significant cost savings, avoiding high treatment costs for infections.
Conclusions:
- Prophylactic intraventricular vancomycin completely eliminated OmR-associated infections.
- The strategy demonstrated no added toxicity.
- This approach offers substantial cost savings and improves patient outcomes.
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