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Evaluation of Neonates with Ventriculitis

Year 2013, Volume: 38 Issue: 4, 553 - 558, 01.12.2013

Abstract

Backgroud: Neonatal meningitis and ventriculitis still remain a problem with high mortality in spite of systemic and intraventricular antibiotics. Ventriculitis due to repeated taps is a serious problem of posthemorragic hydrocephalus in preterm infants. Methods: In this study, we evaluated 16 infants with ventriculitis followed at Cukurova University Faculty of Medicine Neonatal Intensive Care Unit between January 1999-December 2004. Results: Mean gestational week was 33± 5 (25-40) weeks and mean birth weight was 2096 ± 912 (980-3500) grams. Venticulitis was diagnosed at 38 ± 22 days. Eleven of the infants had intraventricular hemorrhage and 15 had hydrocephalus, 5 of whom had congenital hydrocephalus. Drainage of CSF was performed by taps in 13 infants. Gram negative microorganisms (Klebsiella pneumonia, Pseudomonas aeruginosa) were predominating in cultures. Both intravenous and intraventricular antibiotic treatment was performed according to the cerebrospinal fluid cultures. Vancomycine and amicasine as intraventricular therapy were performed for 28 ±17 days. Cerebrospinal fluid protein levels increased significantly at 8 infant during intraventricular therapy. Mean cerebrospinal fluid protein at the begining of intraventricular treatment was 624.1± 429.1 (109-1330) mg/dl while on 14th day of treatment it was 993.7± 582.2 (89-1750) mg/dl. Seven of the infants were ventriculoperitoneal shunted 6 of them were reinfected. Seven of the infants were died during treatment, 1 infant with ventriculoperitoneal shunt was treated and 8 infants were discharged during treatment because of parents" refusal of therapy. Conclusion: Despite the new treatment regimens, the ventriculitis still remains a problem because of nonstandardized practice in neonatal care.

References

  • Volpe JJ. Bacterial and Fungal Intracranial Infections. In: Neurology of Newborn 4th eds. Saunders, Philadelphia. 2001; 774-810.
  • Kaiser AB, McGee ZA. Aminoglycoside therapy of gram-negative bacillary meningitis. N Engl J Med. 1975; 11;293:1215-20.
  • De Bels D, Korinek AM, Bismuth R, Trystram D, Coriat P, Puybasset L. Empirical treatment of adult postsurgical nosocomial meningitis. Acta Neurochir. 2002 ;144: 989-95.
  • Pfausler B, Spiss H, Beer R, Kampl A, Engelhardt K, Schober M, Schmutzhard E. Treatment of staphylococcal ventriculitis associated with external cerebrospinal fluid drains: a prospective randomized trial of intravenous compared with intraventricular vancomycin therapy. J Neurosurg. 2003 ;98:1040-4.
  • Schultz M, Moore K, Foote AW. Bacterial ventriculitis and duration of ventriculostomy catheter insertion. J Neurosci Nurs. 1993; 25:158-64.
  • Bayston R, Hart CA, Barnicoat M. Intraventricular vancomycin in the treatment of ventriculitis associated with cerebrospinal fluid shunting and drainage. J Neurol Neurosurg Psychiatry. 1987; 50:1419-23.
  • Shah S, Ohlsson A, Shah V. Intraventricular antibiotics for bacterial meningitis in neonates. Cochrane Database Syst Rev. 2004: 18; CD004496.
  • Nieto Del Rincon N, de Alba Romero C, Egea Nadal P, Mateos Beato F, Peralta Ibanez ML, Ramos Amador JT, Miralles Molina M, Gomez del Castillo E. Experience with ventriculitis at a neonatology department. An Esp Pediatr. 2000 ;52:245-50.
  • Schretlen E, Muytjens H, Slooff J. Neonatal meningitis, ventriculitis, intraventricular therapy or not? Tijdschr Kindergeneeskd. 1985 ;53:136-41.
  • Hammersen G, Wille L. Technique for intraventricular application of antibiotics in bacterial meningitis of the newborn (author's transl). Monatsschr Kinderheilkd 1981 ;129:525-8.
  • Baumeister FA, Hofer M, Kuster H, Belohradsky BH. CSF interleukin-6 in neonatal Citrobacter ventriculitis after meningitis. Infection. 2000 ;28:243-5.
  • Barnes BJ, Wiederhold NP, Micek ST, Polish LB, Ritchie DJ. Enterobacter cloacae ventriculitis successfully treated with cefepime and gentamicin: case report and review of the literature. Pharmacotherapy. 2003 ;23:537-42.
  • Wen DY, Bottini AG, Hall WA, Haines SJ. Infections in neurologic surgery. The intraventricular use of antibiotics. Neurosurg Clin N Am. 1992 ;3:343-54.
  • Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm J Pediatr. 1978 ;92:529-34.
  • Raine PA, Young DG, McAllister TA, Tait SC. Tobramycin in pediatric use. J Infect Dis. 1976;134:165-9.
  • Winking M, Schroth I, Joedicke A, Boeker DK. Technical note: external cerebrospinal fluid (CSF) drainage by percutaneous needle punction in newborn children. Acta Neurochir. 1999;141:1093-4.
  • Calderon E, Hernandez M, Gonzalez N, Cob C, Martinez E. Neonatal meningoventriculitis. Bol Med Hosp Infant Mex. 1977; 34:117-28.
  • Baumeister FA, Pohl-Koppe A, Hofer M, Kim JO, Weiss M. IL-6 in CSF during ventriculitis in preterm infants with posthemorrhagic hydrocephalus. Infection. 2000;28: 234-6.
  • Feigin RD, Matson DO: the comprimised host. In: Feigin RD, Cherry JD(eds): Textbook of pediatric infectious diseases. Saunders, Philadelphia. 1992; 960Yeung CY. Intrathecal antibiotic therapy for neonatal meningitis. Arch Dis Child. 1976 ;51:686-90.
  • Bruckner O, Alexander M, Collmann H. Tobramycin levels in cerebrospinal fluid of patients with slightly and severely impaired blood-cerebrospinal barrier. Chemotherapy. 1981; 27:303-8.
  • Nagl M, Neher C, Hager J, Pfausler B, Schmutzhard E, Allerberger F. Bactericidal activity of vancomycin in cerebrospinal fluid. Antimicrob Agents Chemother. 1999; 43:1932-4.
  • Yogev R, Kolling WM. Intraventricular levels of amikacin after intravenous administration. Antimicrob Agents Chemother. 1981; 20:583-6.
  • Yazışma Adresi / Address for Correspondence: Dr. Dr Ferda Ozlu Cukurova University Faculty of Medicine, Neonatology Department, 01330 Balcalı-ADANA e-mail: fozlu@cu.edu.tr geliş tarihi/received :07.03.2013 kabul tarihi/accepted:15.04.2013

Ventrikülit Tanısı Alan Yenidoğan Bebeklerin Değerlendirilmesi

Year 2013, Volume: 38 Issue: 4, 553 - 558, 01.12.2013

Abstract

Giriş: Neonatal menenjit ve ventrikülit, sistemik ve intraventriküler antibiotik tedavilerine rağmen hala yüksek mortalite oranlarına sahip problemlerdir. Preterm infantlarda posthemorajik hidrosefali ciddi bir problem olmakla beraber tekaralanan ventriküler girişimlerde ventrikülit oluşumuna neden olmaktadır. Materyal ve Metod: Çalışmamızda Çukurova Üniversitesi Tıp Fakültesi yeni doğan yoğun bakım ünitesinde Ocak 1999-Aralık 2004 tarihleri arasında takip edilen ve ventrikülit tanısı konulmuş 16 yenidoğan değerlendirilmiştir. Bulgular:Ortalama gebelik haftası 33±5 (25-40) hafta ve ortalama doğum ağırlığı ise 2090±912 (980-3500) gramdı. Ventrikülit tanısı yaklaşık 38±22. günlerde konuldu. 11 infantta intraventriküler hemoraj ve 15 infantta hidrosefali vardı ki bunların 5 tanesi konjenital hidrosefalidir. 13 infantta serebrospinal sıvı (BOS) taps ile drene edildi. Kültürü yapılan sıvıda GR(-) bakteriler (klebsiella pnömoni, Pseudomonas auroginasa) baskın olarak bulundu. BOS kültür sonuçlarına göre intraventriküler ve intravenöz tedavi yöntemi uygulandı. 28±17 gün intraventriküler olarak vankomisin ve amikasin tedavisi uygulandı. İntraventriküler tedavi sırasında 8 infanta ait BOS proteinleri seviyelerinde artışlar görülmüştür. İntraventriküler tedaviye başlarken BOS protein miktarı ortalama 624,1±429,1 (109-1330) mg/dl iken tedavinin 14. günü bu oran 993,7±582,2 (89-1750) mg/dl olmuştur. Ventriküloperitoneal şantı olan 7 infanttan 6 sında enfeksiyon tekrarı gözlenmiştir. İnfantların 7 si tedavi sırasında yaşamını yitirmiştir, ventriküloperitoneal şantı olan 1 infant tedavi edilirken, ailesi tedaviyi reddeden 8 infant taburcu edilmiştir. Sonuç: Yeni tedavi metodlarının geliştirilmesine rağmen, ventrikülit neonatal bakımda belirli bir standardizasyon olmamasında ötürü halen önemli bir problemdir.

References

  • Volpe JJ. Bacterial and Fungal Intracranial Infections. In: Neurology of Newborn 4th eds. Saunders, Philadelphia. 2001; 774-810.
  • Kaiser AB, McGee ZA. Aminoglycoside therapy of gram-negative bacillary meningitis. N Engl J Med. 1975; 11;293:1215-20.
  • De Bels D, Korinek AM, Bismuth R, Trystram D, Coriat P, Puybasset L. Empirical treatment of adult postsurgical nosocomial meningitis. Acta Neurochir. 2002 ;144: 989-95.
  • Pfausler B, Spiss H, Beer R, Kampl A, Engelhardt K, Schober M, Schmutzhard E. Treatment of staphylococcal ventriculitis associated with external cerebrospinal fluid drains: a prospective randomized trial of intravenous compared with intraventricular vancomycin therapy. J Neurosurg. 2003 ;98:1040-4.
  • Schultz M, Moore K, Foote AW. Bacterial ventriculitis and duration of ventriculostomy catheter insertion. J Neurosci Nurs. 1993; 25:158-64.
  • Bayston R, Hart CA, Barnicoat M. Intraventricular vancomycin in the treatment of ventriculitis associated with cerebrospinal fluid shunting and drainage. J Neurol Neurosurg Psychiatry. 1987; 50:1419-23.
  • Shah S, Ohlsson A, Shah V. Intraventricular antibiotics for bacterial meningitis in neonates. Cochrane Database Syst Rev. 2004: 18; CD004496.
  • Nieto Del Rincon N, de Alba Romero C, Egea Nadal P, Mateos Beato F, Peralta Ibanez ML, Ramos Amador JT, Miralles Molina M, Gomez del Castillo E. Experience with ventriculitis at a neonatology department. An Esp Pediatr. 2000 ;52:245-50.
  • Schretlen E, Muytjens H, Slooff J. Neonatal meningitis, ventriculitis, intraventricular therapy or not? Tijdschr Kindergeneeskd. 1985 ;53:136-41.
  • Hammersen G, Wille L. Technique for intraventricular application of antibiotics in bacterial meningitis of the newborn (author's transl). Monatsschr Kinderheilkd 1981 ;129:525-8.
  • Baumeister FA, Hofer M, Kuster H, Belohradsky BH. CSF interleukin-6 in neonatal Citrobacter ventriculitis after meningitis. Infection. 2000 ;28:243-5.
  • Barnes BJ, Wiederhold NP, Micek ST, Polish LB, Ritchie DJ. Enterobacter cloacae ventriculitis successfully treated with cefepime and gentamicin: case report and review of the literature. Pharmacotherapy. 2003 ;23:537-42.
  • Wen DY, Bottini AG, Hall WA, Haines SJ. Infections in neurologic surgery. The intraventricular use of antibiotics. Neurosurg Clin N Am. 1992 ;3:343-54.
  • Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm J Pediatr. 1978 ;92:529-34.
  • Raine PA, Young DG, McAllister TA, Tait SC. Tobramycin in pediatric use. J Infect Dis. 1976;134:165-9.
  • Winking M, Schroth I, Joedicke A, Boeker DK. Technical note: external cerebrospinal fluid (CSF) drainage by percutaneous needle punction in newborn children. Acta Neurochir. 1999;141:1093-4.
  • Calderon E, Hernandez M, Gonzalez N, Cob C, Martinez E. Neonatal meningoventriculitis. Bol Med Hosp Infant Mex. 1977; 34:117-28.
  • Baumeister FA, Pohl-Koppe A, Hofer M, Kim JO, Weiss M. IL-6 in CSF during ventriculitis in preterm infants with posthemorrhagic hydrocephalus. Infection. 2000;28: 234-6.
  • Feigin RD, Matson DO: the comprimised host. In: Feigin RD, Cherry JD(eds): Textbook of pediatric infectious diseases. Saunders, Philadelphia. 1992; 960Yeung CY. Intrathecal antibiotic therapy for neonatal meningitis. Arch Dis Child. 1976 ;51:686-90.
  • Bruckner O, Alexander M, Collmann H. Tobramycin levels in cerebrospinal fluid of patients with slightly and severely impaired blood-cerebrospinal barrier. Chemotherapy. 1981; 27:303-8.
  • Nagl M, Neher C, Hager J, Pfausler B, Schmutzhard E, Allerberger F. Bactericidal activity of vancomycin in cerebrospinal fluid. Antimicrob Agents Chemother. 1999; 43:1932-4.
  • Yogev R, Kolling WM. Intraventricular levels of amikacin after intravenous administration. Antimicrob Agents Chemother. 1981; 20:583-6.
  • Yazışma Adresi / Address for Correspondence: Dr. Dr Ferda Ozlu Cukurova University Faculty of Medicine, Neonatology Department, 01330 Balcalı-ADANA e-mail: fozlu@cu.edu.tr geliş tarihi/received :07.03.2013 kabul tarihi/accepted:15.04.2013
There are 23 citations in total.

Details

Primary Language Turkish
Journal Section Research
Authors

Ferda Özlü This is me

Hacer Yapicioglu This is me

Kenan Ozcan This is me

Nejat Narlı This is me

Mehmet Satar This is me

Publication Date December 1, 2013
Published in Issue Year 2013 Volume: 38 Issue: 4

Cite

MLA Özlü, Ferda et al. “Ventrikülit Tanısı Alan Yenidoğan Bebeklerin Değerlendirilmesi”. Cukurova Medical Journal, vol. 38, no. 4, 2013, pp. 553-8.