Intrathecal or intraventricular antimicrobial therapy for postneurosurgical intracranial infection due to MDR/XDR Gram-negative bacteria: a systematic review and meta-analysis

Abstract This review investigated the effectiveness and safety of intrathecal or intraventricular (ITH/IVT) antimicrobial therapy for postneurosurgical intracranial infection due to multidrug-resistant (MDR) and extensively drug resistant (XDR) Gram-negative bacteria. We searched PubMed, EMBASE and the Cochrane Library database for clinical studies that compared the addition of ITH/IVT therapy with intravenous (IV) monotherapy in the treatment of postneurosurgical intracranial infection due to MDR/XDR Gram-negative bacteria. Eligible articles were analyzed using Stata/SE software v.12.0. Publication bias was assessed using Begg's funnel plot and Egger's test. Nine studies involving 296 patients were included. The OR for death (IV+ITH/IVT vs. IV) reported in the included studies ranged from 0.02 to 0.93. The overall pooled OR was 0.15 (95% CI 0.08-0.28, p