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[Study on treatment strategy for ventriculitis associated with ventriculoperitoneal shunt for hydrocephalus].

OBJECTIVE
To study the treatment strategy for ventriculitis associated with ventriculo peritoneal shunt for hydrocephalus.


METHODS
For all of the patients suspected to have cerebrospinal fluid (CSF) infections, the first step of treatment was removal of the "infected" shunts, then a ventricular drainage was placed in frontal horn of the ventricle, and at the same time CSF was obtained from the ventricle for bacterial culture and tests of bacterial sensitivities to antibiotics. After the shunt removal and before the result from bacterial cultures was obtained, 25-50 mg of vancomycin was administered intraventricularly daily. As soon as the result from bacterial cultures was obtained, antibiotics should be adjusted according to the sensitivity test result. By the time of the infections being controlled, appropriate treatments including reshunting would finally be given for hydrocephalus if necessary.


RESULTS
Among 11 patients, 9 were infected with coagulase-negative Staphylococci or Staphylococcus epidermidis and Staphylococcus aureus, one of them with concomitant infection of aerobacter cloacae, Klebsiella pneumoniae and enterobacteriaceae aerogenesis, 1 patient with Streptococci, and another one with Mycobacterium stercoris bovis. The tests of drug sensitivity showed that cocci in infection of 9 patients were all sensitive to vancomycin, but only 1 of them sensitive to gentamycin. There were other sensitive antibiotics for streptococcus in 1 case and for bacillus in 2 patients. Practically vancomycin was effective for 8 of 11 patients, including one case of streptococcal infection. The duration for anti-infection treatment was in a range of 16-36 days. Finally, all of 11 patients survived from the shunt ventriculitis, and 9 of them had significant improvement in their neurological functions.


CONCLUSION
(1)Intraventricular administration of proper antibiotics is a reliable and effective way to treat ventriculitis associated with ventriculoperitoneal shunts. (2)Vancomycin is the preferred antibiotic for ventriculitis, but other kind(s) of some antibiotics are necessary in a few patients in addition to or instead of vancomycin. (3)The effect of systemic use of antibiotics could not be defined in this series of patients, but this may be used as an adjunct in the practice. (4)There are many problems related to diagnosis and treatment of shunt ventriculitis that should be studied more extensively and deeply.