Ventriculitis: A Retrospective Cohort Study of Clinical Features, Outcomes and Device Management Practices

Ventriculitis is a severe central nervous system infection, often secondary to intraventricular device use or neurosurgical procedures, with high morbidity and mortality. Diagnostic criteria remain debated, and treatment strategies lack standardization.

We conducted a retrospective cohort study from 2014 to 2022 to describe the clinical characteristics, microbiological profile, treatment strategies, and outcomes of ventriculitis at a tertiary care center. Additionally, we compared outcomes before and after the implementation of an updated intraventricular device management protocol.

A total of 403 positive cerebrospinal fluid cultures were identified during the study period. Among these, 87 fulfilled clinical and microbiological criteria for ventriculitis. Healthcare-associated cases predominated (73 [83.9%]), with neurosurgical interventions (72 [82.8%]) and external ventricular drain use (54 [62.1%]) as the most prevalent risk factors. The most common pathogens were coagulase-negative staphylococci (42 [48.3%]), particularly Staphylococcus epidermidis (33 [37.9%]). Fever (56 [64.4%]) and altered consciousness (40 [45.9%]) were the most frequent symptoms. Attributable mortality reached 33.3% (29/87), increasing to 39.1% (34/87) within 1 year postepisode. The introduction of the updated protocol may have contributed to a reduction in mortality between the study periods (relative risk, 0.45 [95% confidence interval, .32-.78]; P = .003). Among discharged patients, 67.3% (37/55) experienced neurological sequelae. Predictors of higher mortality included CSF protein ≥1 mg/mL at diagnosis and a Glasgow Coma Scale score ≤8 during the clinical course.

Ventriculitis remains a complex and life-threatening condition with considerable diagnostic and management challenges. Our findings suggest that standardized intraventricular device care protocols may contribute to improved outcomes, although further evaluation is needed.