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Child's Nervous System
Published in: Child's Nervous System 3/2018

01-03-2018 | Original Paper

Monitoring intraventricular vancomycin for ventriculostomy access device infection in preterm infants

Authors: Jaya Madhura Parasuraman, Mahableshwar Albur, Greg Fellows, Axel Heep

Published in: Child's Nervous System | Issue 3/2018

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Abstract

Purpose

Ventriculitis is a known complication during external CSF drainage in preterm infants with posthaemorrhagic ventricular dilatation. Staphylococci are most frequently isolated in device-associated ventriculitis, and hence, intraventricular vancomycin is a commonly used therapy. Our aim was to study the CSF vancomycin level pattern and drug safety in ventriculostomy access device infection in preterm infants less than 28 weeks gestation.

Methods

This single-centre, retrospective case series included seven infants with a median gestational age of 25 + 4 weeks (range 23 + 6 to 27 + 5 weeks). Ventriculitis was defined as elevated CSF white cell count of > 20/mm3 or positive CSF culture. The CSF vancomycin concentrations following intraventricular vancomycin administration were studied.

Results

Forty treatment episodes of intraventricular vancomycin administration were studied in seven preterm infants. Maximum CSF vancomycin concentrations were 24.9 mg/L (3 mg, n = 8, observed concentration-time (OCT), hours (h) = 19), 96.3 mg/L (5 mg, n = 17, OCT(h) = 14), 94 mg/L (10 mg, n = 14, OCT(h) = 24), and 230.7 mg/L (15 mg, n = 1, OCT(h) = 24). The threshold for re-dosage is set at CSF vancomycin level of < 10 mg/L. In all patients, ventriculitis resolution (defined as sterile CSF and CSF WCC of < 20/mm3) was achieved in a median of 5.5 days (range 2–31 days). Individual microbiology data is provided in the online resource.

Conclusion

Intraventricular vancomycin is an effective treatment for ventriculostomy access device infection in preterm infants. In doses ranging from 3 to 15 mg, sufficient CSF vancomycin level is generated to achieve microbiological cure without any reported adverse effects. Daily CSF drug monitoring is recommended to define dosage interval to maintain drug concentration above breakpoint of minimum inhibitory concentration.
Appendix
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Metadata
Title
Monitoring intraventricular vancomycin for ventriculostomy access device infection in preterm infants
Authors
Jaya Madhura Parasuraman
Mahableshwar Albur
Greg Fellows
Axel Heep
Publication date
01-03-2018
Publisher
Springer Berlin Heidelberg
Published in
Child's Nervous System / Issue 3/2018
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-017-3623-7

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