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A pediatric case of severe bacterial central nervous system infection successfully treated with continuous

Satoshi Kitamura1, Kohei Kanaya2, Kotaro Nakamura1

  • 1Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.

Child'S Nervous System : Chns : Official Journal of the International Society for Pediatric Neurosurgery
|December 1, 2025
PubMed

Insights

Continuous intrathecal antibiotic perfusion successfully treated a pediatric case of refractory bacterial meningitis and hydrocephalus. This salvage therapy achieved full neurological recovery, avoiding permanent cerebrospinal fluid diversion.

Area of Science:

  • Pediatric Infectious Diseases
  • Neurocritical Care
  • Antibiotic Therapy

Background:

  • Bacterial infections of the central nervous system (CNS) in children carry significant risks, especially with antibiotic resistance or disrupted cerebrospinal fluid (CSF) dynamics.
  • A 14-year-old boy experienced severe CNS complications, including meningitis, ventriculitis, and hydrocephalus, from Streptococcus intermedius infection, unresponsive to standard treatments.

Purpose of the Study:

  • To evaluate the efficacy of continuous intraventricular-lumbar intrathecal antibiotic perfusion as a salvage therapy for refractory pediatric CNS infections.
  • To assess the safety and potential of this method in achieving uniform antibiotic distribution and restoring CSF circulation.

Main Methods:

  • The patient underwent continuous intraventricular-lumbar intrathecal antibiotic perfusion using vancomycin and gentamicin.
  • This approach aimed to ensure consistent antibiotic levels and maintain steady CSF flow through dual drainage.

Main Results:

  • The perfusion therapy led to progressive radiological and clinical improvement.
  • The patient achieved complete neurological recovery without recurrence during the follow-up period.

Conclusions:

  • Continuous dual-drain perfusion is a potentially effective and safe salvage strategy for complex pediatric CNS infections.
  • This innovative approach may offer an alternative to permanent CSF diversion in refractory cases.

Keywords:
Antibiotic intrathecal therapyBrain abscessCentral nervous system infectionContinuous intraventricular‒lumbar intrathecal perfusionPediatric neurosurgeryVentriculitis

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