Serial Neuroendoscopic Lavage for the Treatment of Elevated Cerebrospinal Fluid Protein Levels in Infants with Gram-negative Rod Ventriculitis

Introduction: Gram-negative rod (GNR) bacterial ventriculitis is a rare complication of shunt-dependent hydrocephalus, often requiring an extended and invasive treatment course. Accumulation of purulent material, as well as empyema and septation formation, limits circulation of antibiotics and infection clearance. Supplementation of standard care with neuroendoscopic-guided intraventricular lavage with lactated Ringer solution and fenestration of septations may facilitate infection clearance and simplify the eventual shunt construct required. Here the utility of serial lavage for ventriculitis is described in a population of shunt-dependent neonates and infants at high-risk for morbidity and mortality. Methods: Five infants with shunt-dependent hydrocephalus and subsequent GNR ventriculitis were treated with standard care measures with the addition of serial neuroendoscopic lavage. A retrospective chart review was performed to collect patient characteristics, shunt dependency and shunt revisions within a year of ventriculitis resolution. Results: Patients demonstrated a mean 74% decrease in CSF protein following each neuroendoscopic lavage and trended towards a shorter time to infection clearance in comparison to previously published literature. Patients required 0-2 shunt revisions at 1-yr follow-up following hospitalization for shunt-related ventriculitis (mean 0.8 +/- 0.8). Conclusions: Serial neuroendoscopic lavage is an effective technique, used alone or in combination with fenestration of septations, to reduce the cerebrospinal fluid (CSF) protein and bacterial load in the treatment of ventriculitis, decreasing time until eradication of infection. Serial lavage may reduce the risk of future shunt malfunction, simplify the future shunt construct, and decrease duration of infection.

Automated summary

This study explores the feasibility of serial lavage for the treatment of Gram-negative rod bacterial ventriculitis. The results show that serial lavage can effectively reduce cerebrospinal fluid protein and bacterial load, and shorten the time for infection eradication.