Ventriculitis: A Severe Complication of Central Nervous System Infections

• Published in: Open forum infectious diseases Vol. 8; no. 6; p. ofab216
• Main Authors: Luque-Paz, David, Revest, Matthieu, Eugène, François, Boukthir, Sarrah, Dejoies, Loren, Tattevin, Pierre, Le Reste, Pierre-Jean
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 01.06.2021
• Subjects: Abscesses; Life Sciences; Major; Meningitis; Mortality; Neurosurgery; brain abscess; central nervous system infections; ventriculitis; outcomes; meningitis
• ISSN: 2328-8957; 2328-8957
• DOI: 10.1093/ofid/ofab216

BackgroundVentriculitis, a dreaded complication of brain abscess, meningitis, and various neurosurgical procedures, has attracted limited attention in the medical literature. MethodsThis is a retrospective, single-center study. We screened the medical files of all patients who had a brain imaging report that included the word “ventriculitis” during years 2005–2019. Only patients with clinical, microbiological, and imaging features of ventriculitis were included. Data were collected through a standardized questionnaire. ResultsNinety-eight patients fulfilled inclusion criteria: 42 women and 56 men, and the median age was 60 years (interquartile range, 48–68). The primary mechanism for ventriculitis was classified as follows: brain abscess (n = 29, 29.6%), meningitis (n = 27, 27.6%), intraventricular catheter-related (n = 17, 17.3%), post-neurosurgery (n = 13, 13.3%), and hematogenous (n = 12, 12.2%). The main neuroimaging features were intraventricular pus (n = 81, 82.7%), ependymal enhancement (n = 70, 71.4%), and intraventricular loculations (n = 15, 15.3%). The main pathogens were streptococci (n = 44, 44.9%), Gram-negative bacilli (n = 27, 27.6%), and staphylococci (n = 15, 15.3%). In-hospital and 1-year mortality rates were 30.6% (n = 30) and 38.8% (n = 38), respectively. Neurological sequelae were reported in 34 of 55 (61.8%) survivors, including cognitive impairment (n = 11), gait disturbances (n = 9), paresis (n = 7), behavior disorder (n = 6), and epilepsy (n = 5). On multivariate analysis, age >65 years, Glasgow Coma Scale score <13 at initial presentation, status epilepticus, hydrocephalus, and positive cerebrospinal fluid culture were associated with 1-year mortality. We built a scoring system to stratify patients with ventriculitis into low risk (12.5%), intermediate risk (36.5%), and high risk (71.4%) of death. ConclusionsVentriculitis is a severe complication of brain abscess, meningitis, or neurosurgery, with an in-hospital mortality rate of 30% and neurological sequelae in 60% of survivors. In this case series of 98 patients with ventriculitis, 1-year mortality was 38.8%, and 61.8% of survivors had neurological sequelae. Age >65 years, GCS-score <13 at initial presentation, status epilepticus, hydrocephalus, and positive CSF culture were associated with 1-year mortality.