Ommaya reservoir-related infections: Clinical manifestations and treatment outcomes

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• 作者：Ariel D. Szvalb ; Issam I. Raad ; Jeffrey S. Weinberg ; Dima Suki ; Rory Mayer ; George M. Viola
• 关键词：Central nervous system ; Device ; Infection ; Ommaya reservoir ; Meningitis
• 刊名：Journal of Infection
• 出版年：March, 2014
• 年：2014
• 卷：68
• 期：3
• 页码：216-224
• 全文大小：288 K

文摘

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Summary

Objectives

As infection is a severe complication of Ommaya reservoirs (OR), and existing data is limited, herein we describe the largest study of the clinical manifestations and treatment outcomes of Ommaya reservoir-related infections (ORRI).

Methods

We retrospectively reviewed the records of all patients at our institution who had an OR placed, and developed a definite device-related infection between 2001 and 2011.

Results

Among 501 OR placements, 40 patients (8%) developed an ORRI. These presented with meningitis and/or meningoencephalitis (60%), cellulitis (20%), or a combination thereof (20%). Approximately 40% occurred 鈮?0 days of OR placement, while 60% occurred 鈮?0 days after the device was last accessed. Only 20% presented with leukocytosis, while another 18% had a normal cerebrospinal fluid (CSF). Gram-positive skin flora accounted >80% of the pathogens. The median hospital stay and duration of antibiotics were 13 and 24 days, respectively. Although mortality rates (鈮?0%) were similar among all treatment groups (m>pm>聽>聽0.99), shorter hospitalization and antimicrobial treatment durations were obtained with early versus late device removal (m>pm>聽<聽0.038).

Conclusions

As clinical symptoms can be non-specific and CSF parameters may be within normal limits, a high suspicion for infection is required. The shortest hospitalization and treatment course was achieved with early device removal.