von Spreckelsen Niklas, Jung Norma, Telentschak Sergej, Hampl Jürgen, Goldbrunner Roland, Grau Stefan
Department of Neurosurgery, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
Department of Internal Medicine, University Hospital Cologne, Kerpener Str. 62, Cologne, 50937, Germany.
Acta Neurochir (Wien). 2018 Mar;160(3):505-508. doi: 10.1007/s00701-017-3393-8. Epub 2017 Nov 9.
Iatrogenic ventriculitis is a common complication of the external ventricular drainage. While the procedure and indications for external ventricular drains (EVD) are highly standardized, the treatment of ventriculitis is not clearly defined.
To depict the treatment of iatrogenic ventriculitis currently performed in German hospitals.
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 German Society for Neurosurgery (DGNC).
Thirty-three out of 121 hospitals returned the questionnaire. While diagnostics are performed similarly in most hospitals, the treatment varies remarkably. Ten of the 33 (30%) units never applied antibiotics intrathecally and 12 (36%) only in selected (1-20%) cases, while 7 (21%) do this routinely, and the remaining 4 centers vary their treatment. While the targeted systemic therapy after pathogen identification and resistance testing is similar, the choice of empiric antibiotics varies as does the type of drug used for intrathecal therapy. Among the applied systemic antibiotics, vancomycin [n = 23 (70%)] and meropenem [n = 22 (67%)] were the most common, but many others, including ceftriaxone, metronidazol, linezolid, piperacillin/tazobactam, fosfomycin and ceftazidim, are used. There is no standard practice regarding EVD handling. Twelve (36%) hospitals do not replace the EVD after a new diagnosis of ventriculitis, 13 (39%) do so once after the diagnosis, and 8 (24%) regularly switch EVDs after a defined time span (7-20 days), even without signs of infection.
Treatment concepts for iatrogenic ventriculitis are very heterogeneous. Thus, there is an urgent need for generating outcome data and defining a standard treatment algorithm with the recently published practice guideline being an important first step.
医源性脑室炎是脑室外引流的常见并发症。虽然脑室外引流（EVD）的操作和适应症高度标准化，但脑室炎的治疗尚无明确界定。
描述德国医院目前对医源性脑室炎的治疗情况。
向德国神经外科学会（DGNC）注册的121家神经外科医院发送了一份标准化问卷，该问卷由18个多项选择题组成，每个问题都能提供额外的个人答案，涵盖医源性脑室炎的诊断和治疗以及EVD的一般处理。
121家医院中有33家回复了问卷。虽然大多数医院的诊断方法相似，但治疗方法差异很大。33个单位中有10个（30%）从未鞘内应用抗生素，12个（36%）仅在部分（1%-20%）病例中应用，7个（21%）常规应用，其余4个中心的治疗方法各不相同。虽然病原体鉴定和耐药性检测后的靶向全身治疗相似，但经验性抗生素的选择以及鞘内治疗所用药物的类型各不相同。在应用的全身抗生素中，万古霉素[n = 23（70%）]和美罗培南[n = 22（67%）]最为常见，但也使用了许多其他药物，包括头孢曲松、甲硝唑、利奈唑胺、哌拉西林/他唑巴坦、磷霉素和头孢他啶。在EVD处理方面没有标准做法。12家（36%）医院在新诊断脑室炎后不更换EVD，13家（39%）在诊断后更换一次，8家（24%）在规定时间（7-20天）后定期更换EVD，即使没有感染迹象。
医源性脑室炎的治疗概念非常不一致。因此，迫切需要生成疗效数据并确定标准治疗算法，最近发布的实践指南是重要的第一步。
