Abstract
Background Postneurosurgical meningitis (PNM) is a serious medical condition with high mortality
and morbidity caused by Gram positive organisms like Staphylococcus aureus and Gram-negative organisms like Acinetobacter baumannii . Optimum concentration of antibiotics in the cerebrospinal fluid (CSF) to treat these
infections is difficult to achieve. Intraventricular antibiotic administration bypasses
the blood–brain barrier and can achieve high CSF concentration without causing systemic
toxicity.
Methods Retrospective review of all patient records were done to identify patients who developed
postneurosurgical meningitis and received intraventricular antibiotic therapy during
the period of July 2017 to December 2022. Demographic and clinical data along with
the type of antibiotic, route, dose, and duration of administration were collected.
CSF parameters before and after intraventricular antibiotic administration were collected
and analyzed.
Results Twenty-six patients with postneurosurgical meningitis received intraventricular antibiotic
therapy. Intracranial tumors were the most common underlying pathology followed by
aneurysms. In all, 17/26 patients had received vancomycin and 9/26 patients had received
colistin. External ventricular drain was used in 17/26 cases and Ommaya reservoir
was used in 9/26 cases. Six patients showed growth of organism in CSF before starting
intraventricular antibiotics, while one patient remained culture positive despite
treatment. Of the 26 patients, 3 died despite treatment. There were significant changes
in the CSF parameters after intraventricular antibiotic therapy.
Conclusion Intraventricular administration of antibiotic provides an alternative therapeutic
option in the management of patients who are not responding or poorly responding to
systemic antibiotics.
Keywords intraventricular antibiotics - postoperative complication - intrathecal antibiotics
