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Updated: Mar 18, 2026
Intraventricular Drug Delivery and Sampling for Pharmacokinetics and Pharmacodynamics Study
Published on: March 31, 2022
Intraventricular treatment experience in children with central nervous system infections
Tugce Tural Kara1, Onur Tekeli2
1Akdeniz University Hospital, Department of Pediatric Infectious Disease, Antalya, Turkey. tugcetural@hotmail.com.
Insights
Intraventricular antibiotics show promise for treating pediatric ventriculoperitoneal shunt infections, especially those caused by multidrug-resistant organisms. While effective in sterilizing cerebrospinal fluid without neurotoxicity, patient outcomes depend on sepsis and comorbidities.
Area of Science:
- Pediatric Neurosurgery
- Infectious Diseases
- Pharmacology
Background:
- Ventriculoperitoneal (VP) shunt infections pose significant risks in pediatric neurosurgery.
- Multidrug-resistant (MDR) organisms complicate treatment, increasing morbidity and mortality.
- Intraventricular antibiotic administration is a potential adjunctive therapy.
Purpose of the Study:
- To evaluate the efficacy and safety of intraventricular antibiotic therapy.
- To assess outcomes in pediatric patients with VP shunt infections.
Main Methods:
- Retrospective review of pediatric patients (0-18 years) with VP shunt infections treated with intraventricular antibiotics.
- Data collection included demographics, pathogens, antibiotic regimens, outcomes, complications, and mortality.
Main Results:
- Seven patients (nine episodes) were analyzed; common pathogens included Enterococcus faecium, Staphylococcus haemolyticus, and Klebsiella pneumoniae.
- Cerebrospinal fluid (CSF) sterilization occurred in 77.8% of episodes with no observed neurotoxicity.
- Mortality rates were 33.3% per episode and 28.6% per patient.
Conclusions:
- Intraventricular antibiotics appear effective and safe for VP shunt infections, particularly MDR cases.
- CSF sterilization was common, but systemic sepsis and comorbidities influenced outcomes.
- Further prospective studies are needed to refine dosing and treatment strategies.
Objectives:
Ventriculoperitoneal (VP) shunt infections are a significant cause of morbidity and mortality in pediatric neurosurgery. Intraventricular antibiotic administration has emerged as a potential adjunctive treatment, particularly in infections caused by multidrug-resistant organisms (MDR). This study aims to evaluate the efficacy and safety of intraventricular antibiotic therapy in pediatric patients with VP shunt infections.
Methods:
A retrospective review was conducted on pediatric patients (0-18 years) treated with intraventricular antibiotics for VP shunt infections. Data collected included demographic characteristics, causative microorganisms, antibiotic regimens, treatment duration, clinical and microbiological outcomes, complications, and mortality.
Results:
Seven patients (nine infection episodes) were included. The most frequently isolated pathogens were Enterococcus faecium, Staphylococcus haemolyticus, and Klebsiella pneumoniae. Intraventricular antibiotics used included colistin, vancomycin, tigecycline, and amikacin. CSF sterilization was achieved in 77.8% of episodes. No neurotoxic adverse effects were observed. The episode-based mortality rate was 33.3% (3/9 episodes), whereas the patient-based mortality rate was 28.6% (2/7 patients).
Conclusions:
Intraventricular antibiotic therapy appears to be an effective and safe adjunct in the management of VP shunt infections, particularly those caused by MDR pathogens. While CSF sterilization was achieved in most cases without neurotoxicity, systemic sepsis and comorbidities remained critical determinants of outcome. Further prospective studies are needed to standardize dosing protocols and optimize therapeutic strategies in this high-risk pediatric population.
