Artikel
Current treatment concepts for iatrogenic ventriculitis: a nationwide survey in Germany
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Autoren
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Niklas Von Spreckelsen
- Klinikum der Universität zu Köln, Zentrum für Neurochirurgie, Klinik für Allgemeine Neurochirurgie, Köln, Deutschland
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Sergej Telentschak
- Allgemeine Neurochirurgie, Uniklinik Köln, Klinikum der Universität zu Köln, Zentrum für Neurochirurgie, Labor für Neuroonkologie und experimentelle Neurochirurgie, Köln, Deutschland
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Jürgen Hampl
- Klinikum der Universität zu Köln, Klinik und Poliklinik für Allgmeine Neurochirurgie, Labor für Onkologische Neurochirurgie, Köln, Deutschland
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Roland Goldbrunner
- Klinikum der Universität zu Köln, Zentrum für Neurochirurgie, Klinik für Allgemeine Neurochirurgie, Köln, Deutschland
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Stefan Grau
- Klinik und Poliklinik für Allgemeine Neurochirurgie, Zentrum für Neurochirurgie, Uniklinik Köln, Köln, Deutschland
| Veröffentlicht: | 9. Juni 2017 |
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Gliederung
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Objective: Iatrogenic ventriculitis is a common complication in patients being treated with external ventricular drains (EVD). To date, the treatment of ventriculitis is subject to hospital specific standards without clear guidelines for modality, timeframe and choice of antibiotic treatment. Our objective was to depict the treatment concepts currently performed in German hospitals.
Methods: A standardized questionnaire consisting of 18 multiple choice questions, each with the ability to provide additional individual answers, covering the diagnosis and treatment of iatrogenic ventriculitis as well as general handling of EVDs was sent to 121 neurosurgical hospitals registered in the “Deutsche Gesellschaft für Neurochirurgie” (DGNC) (German Society for Neurosurgery).
Results: Thirty-one out of 121 hospitals returned the questionnaire. While diagnostics are performed similarly in most hospitals, the treatment varies remarkably. Nine of the 31 (29%) hospitals never apply antibiotics intrathecally, 11 (35,5%) do so only in few (10-20%) cases, while 7 (22.7%) do this routinely and the other centers vary their treatment. Similar results were obtained for type of antibiotics, timing of treatment and handling of EVDs. While the targeted systemic therapy after pathogen and resistance identification is similar, the choice of initial antibiotics varies, as well as the type of drug used for intrathecal therapy. Out of all applied systemic antibiotics Vancomycin n=21 (67,8%) and Meropenem n=20 (64,5%) are the most common combination, but many others including, Ceftriaxone, Metronidazol, Linezolid, Piperacillin, Rocephin, Fosfomycin and Ceftazidim are used. In addition, there is no clear practice regarding EVD-handling. 12 (38,7%) hospitals do not replace the EVD after a new diagnosis of ventriculitis, 11 (35,5%) do so once after the diagnosis, and 8 (25,8%) regularly switch EVDs after a certain amount of time, even without signs of infection. (7-20 days).
Conclusion: For treating iatrogenic ventriculitis, various treatment strategies are pursued. The results of this questionnaire show the urgent need for defining a standard treatment algorithm.
