Pathogenetic variants of ventriculitis in children
https://doi.org/10.22625/2072-6732-2020-12-4-37-44
Abstract
The aim of the study: to analyze the pathogenetic structure of ventriculitis, their relationship with age, risk factors, study the etiological characteristics, clinical and diagnostic features, evaluate outcomes of ventriculitis and features of mortality.
Materials and methods: a retrospective analysis of inpatient medical charts of 72 children with ventriculitis received treatment in the neurosurgery department of Filatov Children hospital №5, St-Petersburg, from January 2008 to December 2017 was carried out.
Results: Most cases of ventriculitis occurred in infants (up to 1 year) and young children (1-3 years old). The largest group among pathogenetic variants of ventriculitis was shunt infection – 50 (69.44%) cases. Other groups were: ventriculostomy-associated ventriculitis – 12 (16,67%) cases; ventriculitis following a neurosurgical procedure without external ventricular drainage – 6 (8,33%) cases; ventriculitis complicated meningitis in patients without prior neurosurgery – 4 (5,56%) cases. The presence of such risk factors for ventriculitis as cerebrospinal fluid leakage (18,06%), intraventricular blood prior to the development of ventriculitis (22,22%), and other systemic infections (59,72%) were noted. The crucial role in the diagnosis of ventriculitis is played by the inflammatory changes in the ventricular cerebrospinal fluid on the background of specific clinical findings and indicative anamnesis. The commonest organism causing ventriculitis in the study was Staphylococcus epidermidis – 24 (33,33%) patients. Ventriculitis mortality rate was 8,33% (6 cases). Analysis of adverse outcomes revealed that aggressive health-care-associated multidrug resistant organisms are more dangerous for life, especially in patients with severe central nervous system pathology prior to ventriculitis.
About the Authors
A. S. PozhivilRussian Federation
Saint-Petersburg
A. Yu. Shcherbuk
Russian Federation
Saint-Petersburg
A. P. Lyapin
Russian Federation
Saint-Petersburg
Yu. A. Shcherbuk
Russian Federation
Saint-Petersburg
References
1. Obshhaja zabolevaemost’ vsego naselenija Rossii v 2017 godu. Statisticheskij sbornik 2017 god [Internet]. Available from: https://www.rosminzdrav.ru/ministry/61/22/stranitsa-979/statisticheskie-i-informatsionnye-materialy/statisticheskiy-sbornik-2017-god (in Russian).
2. Rubin A.N. Problemy diagnostiki i lechenija gnojnovospalitel’nyh zabolevanij golovnogo mozga (obzor literatury) / A.N. Rubin, Ju.A. Shherbuk, A.A. Krivopalov // Zhurn. «Vestnik hirurgii im. I.I. Grekova». – 2016. – Vol. 175. – № 4. – P. 91-96 (in Russian).
3. Krivopalov A.A. Vnutricherepnye gnojno-vospalitel’nye oslozhnenija otogennoj jetiologii (obzor literatury) / A.A. Krivopalov, Ju.K. Janov, A.Ju. Shherbuk i soavt. // Zhurn. «Vestnik hirurgii im. I.I. Grekova». – 2017. – Vol. 176. – № 6. – P. 101-105 (in Russian).
4. Hachatrjan V.A. Infekcionno-vospalitel’nye oslozhnenija likvoroshuntirujushhih operacij. Shunt-infekcija / V.A. Hachatrjan, Ju.A. Orlov, A.V. Kim // Oslozhnenija klapannyh likvoroshuntirujushhih operacij. – SPb: FGBU «RNHI im. prof. A.L. Polenova», 2013 – Ch.3. – P. 123-181 (in Russian).
5. Conen A. Characteristics and treatment outcome of cerebrospinal fluid shunt-associated infections in adults: a retrospective analysis over an 11-year period / A. Conen, L.N. Walti, A. Merlo [et al.] // Clin Infect Dis. – 2008. – Vol. 47, №1. – P. 73-82.
6. Tabuchi S. Neuroendoscopic surgery for ventriculitis and hydrocephalus after shunt infection and malfunction: Preliminary report of a new strategy / S. Tabuchi, M. Kadowaki // Asian J Endosc Surg. – 2015. – Vol. 8, №2. – P. 180-184.
7. Anderson C.O. Tsang, Gilberto K.K. Leung. Hydrocephalus (Edited by Dr Sadip Pant). InTech; c 2012. Chapter 7, External Ventricular Drain Infections; p. 87-98. Available from: https://cdn.intechopen.com/pdfs-wm/29504.pdf.
8. Lewis A. Variations in Strategies to Prevent Ventriculostomy-Related Infections: A Practice Survey / A. Lewis, B.M. Czeisler, A.S. Lord // Neurohospitalist. – 2017. – Vol. 7, №1. – P. 15-23.
9. Kurdjumova N.V. Drenazh-associirovannye meningity u pacientov otdelenija nejroreanimacii. Rezul’taty pjatiletnego prospektivnogo nabljudenija / N.V. Kurdjumova, O.N. Ershova, I.A. Savin i soavt. // Zhurnal «Voprosy nejrohirurgii» imeni N.N. Burdenko. – 2017. – Vol. 81, № 6. – P. 56-63 (in Russian).
10. Hussein K. Management of post-neurosurgical meningitis: narrative review / K. Hussein, R. Bitterman, B. Shofty, M. Paul [et al.] // Clin Microbiol Infect. – 2017. – Vol. 23, №9. P. 621-628.
11. CDC/NHSN Surveillance Definitions for Specific Types of Infections [Internet]. 2019 Jan. Available from: www.cdc.gov/nhsn/PDFs/pscManual/17pscNosInfDef_current.pdf.
12. Beer R. Nosocomial ventriculitis and meningitis in neurocritical care patients / R. Beer, P. Lackner, B. Pfausler, E. Schmutzhard // J Neurol. – 2008. – Vol. 255, №11. – P. 1617– 1624.
13. Fotakopoulos G. Outcomes in meningitis/ventriculitis treated with intravenous or intraventricular plus intravenous colistin / G. Fotakopoulos, D. Makris, M. Chatzi [et al.] //Acta Neurochir (Wien). – 2016. – Vol. 158, №3. – P. 603-610.
14. Srihawan C., Castelblanco R.L., Salazar L. et al. Clinical Characteristics and Predictors of Adverse Outcome in Adult and Pediatric Patients With Healthcare-Associated Ventriculitis and Meningitis // Open Forum Infect Dis [Internet]. 2016 Apr 13; 3(2). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4943569/pdf/ofw077.pdf.
15. Krivopalov A.A. Vnutricherepnye gnojno-vospalitel’nye zabolevanija otogennoj i rinosinusogennoj jetiologii / A.A. Krivopalov, A.Ju. Shherbuk, Ju.A. Shherbuk, Ju.K. Janov. – SPb., 2018. – 234 p (in Russian).
16. Pozhivil A.S. Diagnostika i lechenie bol’nyh s ventrikulitami (obzor literatury) / A.S. Pozhivil, A.Ju. Shherbuk, A.P. Ljapin, Ju.A. Shherbuk // Zhurn. «Vestnik hirurgii im. I.I. Grekova». – 2018. – Vol. 177. – № 1. – P. 94-99 (in Russian).
17. Rubin A.N. Oslozhnenija gnojnyh meningojencefalitov u detej / A.N. Rubin, Ju.A. Shherbuk, A.P. Ljapin // Zhurn. «Vestnik hirurgii im. I.I. Grekova». – 2015. – Vol. 174. – № 1. – P. 43-46 (in Russian).
18. Piskunov I.S. Neotlozhnaja luchevaja diagnostika vnutricherepnyh gnojno-vospalitel’nyh otorinosinusogennyh oslozhnenij / I.S. Piskunov, Ju.A. Shherbuk, A.A. Krivopalov i soavt. // Zhurn. «Vestnik hirurgii im. I.I. Grekova». – 2016. – Vol. 175. – № 3. – P. 54-63 (in Russian).
19. Wang F. Management of Pyogenic Cerebral Ventriculitis by Neuroendoscopic Surgery / F. Wang, X.Y. Yao, Z.R. Zou [et al.] // World Neurosurg. – 2017. – Vol. 98. – P. 6-13.
Review
For citations:
Pozhivil A.S., Shcherbuk A.Yu., Lyapin A.P., Shcherbuk Yu.A. Pathogenetic variants of ventriculitis in children. Journal Infectology. 2020;12(4):37-44. (In Russ.) https://doi.org/10.22625/2072-6732-2020-12-4-37-44