AUTHOR=Corona-Nakamura Ana Luisa , Arias-Merino Martha Judith , Ávila-Esparza Eleazar Iván , Tolentino-Corona María de Lourdes , Cañedo-Castañeda César Cuauhtémoc , Flores-Salinas Héctor Enrique , Corona-Macías Juan Fernando , Vázquez-Arias Martha Elena 

TITLE=Ventriculitis due to multidrug-resistant gram-negative bacilli associated with external ventricular drain: evolution, treatment, and outcomes

JOURNAL=Frontiers in Neurology

VOLUME=Volume 15 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2024.1384206

DOI=10.3389/fneur.2024.1384206

ISSN=1664-2295

ABSTRACT=Introduction: Nosocomial infectious ventriculitis due to multidrug-resistant (MDR) Gram-negative bacilli associated with external ventricular drainage (EVD) placement is a serious problem due to its mortality burden and hospital costs. Objectives: To analyze the characteristics, ventriculitis evolution, treatment, and outcomes of patients with ventriculitis due to MDR Gram-negative bacilli associated with EVD placement. Methods: Through a retrospective cohort study from 2019 to 2022, patients who were on EVD and presented with nosocomial infection by MDR Gram-negative bacilli were selected. Medical, laboratory, and microbiological records were collected, described, and analyzed. Also, description and analyses of the antibiotic resistance of the Gram-negative bacilli isolated in the cerebrospinal fluid (CSF) of patients were carried out. Univariate risk models were used. The risk factors identified were analyzed using survival curves (Cox regression). An adjusted Cox proportional hazards model was also constructed. Results: From a cohort of 530 patients with suspected EVD-associated ventriculitis, 64 patients with isolation of Gram-negative bacilli in CSF were included. A mortality of 78.12% was estimated. Hemorrhages (intracranial, subarachnoid, intraventricular) were present in 69.8% of patients. The most frequently isolated bacilli were Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa. In the univariate analysis, arterial hypertension, Glasgow Coma Scale (GCS) score ≤8, invasive mechanical ventilation (IMV) upon hospital admission and during hospitalization, septic shock, and ineffective treatment were associated significantly with mortality. The adjusted Cox proportional hazards model revealed septic shock (HR = 3.3, 95%CI = 1.5-7.2; p = 0.003) and ineffective treatment (HR=3.2, 1.6-6.5, 0.001) were significant. A high resistance to carbapenems was found for A. baumannii  (91.3%) and P. aeruginosa 80.0%. Low resistance to colistin was found for A. baumannii (4.8%) and P. aeruginosa (12.5%). Conclusions: Ineffective treatment was an independent hazard factor for death in patients with ventriculitis due to MDR Gram-negative bacilli associated with EVD.