1007 SAFETY AND EFFICACY OF INTRAVENTRICULAR GENTAMYCIN IN CENTRAL NERVOUS SYSTEM INFECTIONS

Abstract

Eleven cases of ventriculitis in 10 patients, ranging in age from 1 day to 28 years, were treated with intraventricular gentamycin administered via an external ventricular drainage system. Six of the episodes were associated with Staphylococcal infection 2 with Enterobacter and 1 each with Klebsiella, E. Coli, and Serratia. In each case, a systemic antibiotic to which the organism was sensitive was administered along with the intraventricular gentamycin. Ten of the 11 cases were associated with intraventricular shunt infections and 1 was secondary to S. epidermitis infection in a neonate after meningomyelocoel repair. In all 11 cases, successful sterilization of the CSF was achieved within 16 days (avg. 8.4 days) the average course of gentamycin administration being 15 days (range 5-24 days). Two of the patients subsequently became infected by a different organism which was gentamycin resistant and a third patient was reinfected with S. aureus and was successfully treated with a second course of intraventricular gentamycin. No infants died of their CNS infections. There was no evidence of renal or audiologic toxicity and in 7 patients available for follow-up, there was return of neurologic function consistent with the pre-ventriculitis status. Although recent data question the role of intraventricular gentamycin in the treatment of neonatal gram-negative meningitis, the data presented above suggest that intraventricular gentamycin administered via ventricular tubing is safe and efficacious.

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