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Updated: Jan 28, 2026

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Case Commentary: Intraventricular polymyxin B-small steps, big questions.

Nitin Das Kunnathu Puthanveedu1, Adarsh Bhimraj2

  • 1Section of Infectious Diseases, Department of Internal Medicine, University of Illinois College of Medicine, Peoria, Illinois, USA.

Antimicrobial Agents and Chemotherapy
|January 27, 2026
PubMed
Summary
This summary is machine-generated.

Two patients with carbapenem-resistant gram-negative ventriculitis achieved cure with intraventricular polymyxin B. This highlights potential for targeted therapy in severe central nervous system infections.

Keywords:
HCAVMhealthcare-associated ventriculitis and meningitisintraventricular therapypharmacokineticspolymyxinsventriculitis

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Area of Science:

  • Infectious Diseases
  • Neuroscience
  • Pharmacology

Background:

  • Carbapenem-resistant gram-negative ventriculitis presents a critical challenge due to limited therapeutic options.
  • Ventriculitis, an infection of the cerebrospinal fluid-filled cavities of the brain, requires effective antimicrobial strategies.

Purpose of the Study:

  • To report successful treatment of carbapenem-resistant gram-negative ventriculitis using intraventricular polymyxin B.
  • To investigate antibiotic distribution and drug concentrations within the cerebrospinal fluid in patients with ventriculitis.

Main Methods:

  • Case report detailing the treatment of two patients with severe ventriculitis.
  • Analysis of intraventricular antibiotic distribution and cerebrospinal fluid drug concentrations.
  • Monitoring treatment response to intraventricular polymyxin B therapy.

Main Results:

  • Successful clinical cure in both patients treated with intraventricular polymyxin B.
  • Observed uneven distribution of antibiotics within the ventricles.
  • Demonstrated influence of cerebrospinal fluid drainage on intraventricular antibiotic concentrations.

Conclusions:

  • Intraventricular polymyxin B monotherapy can be effective for carbapenem-resistant gram-negative ventriculitis.
  • Findings suggest a need to re-evaluate optimal intraventricular dosing strategies.
  • The necessity of concurrent intravenous therapy in healthcare-associated ventriculitis requires further investigation.