Intraventricular Vancomycin Instillation for Postcraniotomy Ventriculitis

ABSTRACT

OBJECTIVE: To evaluate the efficiencies, shortcomings and complications of intraventricular(IVT) vancomycin instillation for controlling the postcraniotomy ventriculitis, the authors retrospectively studied clinical, radiological and microbiological profiles of such patients. METHODS: We reviewed medical records and radiological findings of eleven patients with postcraniotomy ventriculitis managed between 1995 and 1999. External ventricular drainage(EVD) was performed for the purpose of retrieving cerebrospinal fluid(CSF) and instilling vancomycin. RESULTS: The mean duration for maintaining EVD elapsed 17.8 days and IVT instillation elapsed 11.9 days. The causative pathogens were revealed in eight patients ; methicillin-resistant Staphylococcus aureus(MRSA) in five, coagulase-negative Staphylococcus epidermidis(CNSE) in three. Vancomycin was instilled to patients with MRSA and CNSE. Empirical vancomycin was instilled to three patients with negative bacterial culture. Seizure was seen in one patient. Except one deceased patient, all showed clinical and laboratory improvement. Therapeutic drug monitoring(TDM) did not show any confidential relationship in three patients' status. CONCLUSION: Intraventricular instillation of vancomycin is an effective and safe method in treatment of the postcraniotomy ventriculitis. Complication is negligible and outcome is favorable in general. However, more refined TDM is required to attain steady CSF antibiotic concentration and prudent antibiotic selection is prerequisite to prevent formidable bacterial drug resistance.