Parasuraman Jaya Madhura, Albur Mahableshwar, Fellows Greg, Heep Axel
Neonatal Intensive Care Unit, Southmead Hospital, Bristol, BS10 5NB, UK.
Department of Medical Microbiology, Southmead Hospital, Bristol, UK.
Childs Nerv Syst. 2018 Mar;34(3):473-479. doi: 10.1007/s00381-017-3623-7. Epub 2017 Oct 24.
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.
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/mm or positive CSF culture. The CSF vancomycin concentrations following intraventricular vancomycin administration were studied.
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/mm) was achieved in a median of 5.5 days (range 2-31 days). Individual microbiology data is provided in the online resource.
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.
脑室炎是出血后脑室扩张的早产儿进行外部脑脊液引流期间已知的并发症。葡萄球菌是与器械相关的脑室炎中最常分离出的病原体，因此，脑室内注射万古霉素是常用的治疗方法。我们的目的是研究孕周小于28周的早产儿脑室造瘘接入装置感染时脑脊液中万古霉素水平模式及药物安全性。
本单中心回顾性病例系列研究纳入了7例婴儿，中位孕周为25 + 4周（范围23 + 6至27 + 5周）。脑室炎定义为脑脊液白细胞计数>20/mm或脑脊液培养阳性。研究了脑室内注射万古霉素后脑脊液中万古霉素的浓度。
对7例早产儿的40次脑室内注射万古霉素治疗过程进行了研究。脑脊液中万古霉素的最高浓度分别为24.9mg/L（3mg，n = 8，观察浓度-时间（OCT），小时（h）= 19）、96.3mg/L（5mg，n = 17，OCT（h）= 14）、94mg/L（10mg，n = 14，OCT（h）= 24）和230.7mg/L（15mg，n = 1，OCT（h）= 24）。重新给药的阈值设定为脑脊液万古霉素水平<10mg/L。所有患者脑室炎均在中位时间5.5天（范围2 - 31天）内得到缓解（定义为脑脊液无菌且脑脊液白细胞计数<20/mm）。在线资源中提供了个体微生物学数据。
脑室内注射万古霉素是治疗早产儿脑室造瘘接入装置感染的有效方法。剂量范围为3至15mg时，可产生足够的脑脊液万古霉素水平以实现微生物学治愈，且无任何不良反应报告。建议每日进行脑脊液药物监测以确定给药间隔，维持药物浓度高于最低抑菌浓度的断点。
