Use of Intrathecal Antibiotic Administration for Treatment of CNS Infections in a Neuro-ICU: A Case Series (P6.033)

BACKGROUND: Intraventricular central nervous system (CNS) infections possess a significant associated morbidity and mortality. There are multiple conflicting opinions as to the relevance of intrathecal (IT) antibiotics, particularly regarding the benefit versus potential harm associated with the side effects of administration. OBJECTIVE: We present a review of ten cases of use of IT antibiotics for management of intraventricular infections. METHODS: Retrospective case series of patients who received IT antibiotics in combination with systemic antibiotics for treatment of intraventricular infection over the past 8 years. RESULTS: Ten patients received IT antibiotic therapy for CNS infection. Admitting diagnoses included head trauma, subarachnoid hemorrhage (SAH), infected ventriculoperitoneal shunt, entrapped 4 th ventricle after old SAH and multiple shunt revisions, mastoiditis with brain abscess, surgical site abscess with meningitis and ventriculitis, and 4 patients with intracranial hemorrhage. All patients received external ventricular drainage (EVD) devices during or prior to transfer to our unit. Mean time from hardware placement to first positive CSF culture was 17.3 days (range 0-65 days). Pathogens cultured from CSF: A.baumannii (3 patients), K.pneumonia (2 patients), Vancomycin-Resistant E.faecalis (2 patients), S.marcens (1 patient), Group A strep (1 patient), and Methicillin-Resistant S.aureus (1 patient). Intrathecally instilled antibiotics included colistin, streptomycin, tobramycin, gentamicin, and vancomycin. Average time to CSF culture clearance was 4.4 days (range 1-11 days in 9 patients) after initiation of intrathecal antibiotics. 1 patient died before CSF cleared. No patients experienced significant side effects attributed to IT antibiotic administration. Mean modified Rankin scale on discharge was 4.75 (range 2-5). One patient is still currently hospitalized. Five patients died due to their underlying medical condition. CONCLUSIONS: We report IT antibiotic therapy as an adjunct for treating CNS infections. Average CSF clearance occurred within 4.4 days of treatment initiation, without significant side effects. Further studies are warranted to support our findings. Disclosure: Dr. Mehta has nothing to disclose. Dr. Jones has nothing to disclose. Dr. Ruiz Cuero has nothing to disclose. Dr. Abdelhak has nothing to disclose. Dr. Rehman has nothing to disclose. Dr. Wellwood has nothing to disclose. Dr. Lasak-Myall has nothing to disclose. Dr. Varelas has received personal compensation for activities with UCB Pharma as an advisory board member.