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Objective: To share the treatment experience of patients with post neurosurgical ventriculitis and meningitis due to Carbapenem resistance Klebsiella pneumonia. Introduction: Post neurosurgical ventriculitis and meningitis due to Carbapenem resistance Klebsiella pneumonia is rare and extremely difficult to treat. Increasing resistance to the available antimicrobials has restricted the treatment strategies as a last resort or, unfortunately, none, sometimes. Materials and method: Data of patients with post neurosurgical ventriculitis due to Carbapenem resistance Klebsiella pneumonia were collected retrospectively. The isolated organisms were treated based on the sensitivity report of the cerebrospinal fluid analysis with intravenous and intraventricular antimicrobials. The outcome was assessed based on the clinical, imaging and lab parameters. Results: We identified eight patients (two females) with post neurosurgical ventriculitis and meningitis due to Carbapenem resistance Klebsiella pneumonia. Their age ranged from 6 to 65 years. The CSF analysis showed sensitivity to Colistin and newer antimicrobial Ceftazidime-Avibactam. Based on our prior experience, 5/8 patients were initially started on intravenous and intraventricular Colistin. Later, they were switched to intravenous Ceftazidime and Avibactam due to nonresponse to the initial combined intravenous and intraventricular Colistin therapy. The rest of the 3 patients were given straight IV Ceftazidime and Avibactam as a first-line antimicrobial following the sensitivity report. Though, patients showed improved responses to the newer combination of antimicrobial Ceftazidime and Avibactam; only 5/8 were cured. Conclusion: Intravenous CZA-AVI can be considered first line or as a sequential, targeted treatment to prior intravenous and intraventricular, colistin for post neurosurgical ventriculitis and meningitis due to Carbapenem resistance organisms.

Cranioplasty with polyetheretherketone (PEEK) has recently shown better cerebral protection performance, improved brain function, and aesthetic contour compared with titanium mesh. However, whether patients undergoing PEEK cranioplasty tend to develop subgaleal effusions remains elusive. This retrospective study included patients who underwent cranioplasty with PEEK implants or titanium mesh after decompressive craniectomy between July 2017 and July 2020. Patient information, including general information, location, size of the defect, subgaleal depth, and brain midline shift was collected and statistically analyzed. There were 130 cases of cranioplasty, including 35 with PEEK implants and 95 with a titanium mesh. Patients who underwent cranioplasty with a PEEK implant had a higher subgaleal effusion rate than those who underwent cranioplasty with titanium mesh (85.71% vs. 53.68%, P 5 mm was more frequently observed in the PEEK group than in the titanium group (20% vs. 6.3%, P = 0.021). The PEEK material was the only factor associated with subgaleal effusion after cranioplasty (OR 5.589, P = 0.002). Logistic regression analysis further showed that age was a protective factor against midline shift in the PEEK cranioplasty group (OR 0.837, P = 0.029). Patients who underwent cranioplasty with PEEK implants were more likely to develop severe subgaleal effusion and significant brain midline shifts than those with titanium mesh implants.

ObjectiveHydrocephalus is common after ventriculitis. This study explores hydrocephalus's clinical characteristics following pyogenic ventriculitis due to multidrug-resistant and extensively drug-resistant Acinetobacter baumannii and Klebsiella pneumoniae.Patients and MethodsWe retrospectively reviewed patients with post-neurosurgical pyogenic ventriculitis due to multidrug-resistant and extensively drug-resistant A. baumannii and K. pneumoniae in our department between January 2014 and June 2020. Once diagnosed, patients received intraventricular lavage followed by daily intraventricular administration of Colistin (polymyxin-E). The patient's clinical/radiographic findings were analyzed and evaluated 6 months after discharge.ResultsIn total, 48 cases were included in this study, and 25% were female. The median age was 45 (SD ± 15) years old. Median intraventricular Colistin administration to acquire sterile cerebrospinal fluid (CSF) was 20 days. Forty-one patients developed hydrocephalus; among them, 18 (43%) had multiloculated hydrocephalus (MLH), 23 (56%) had uni/non-loculated hydrocephalus (ULH/NLH), and 7 (17%) did not develop hydrocephalus. The patients with MLH had (15 days) delayed initiation of intraventricular irrigation (p < 0.022). They had (32 days) longer intraventricular Colistin (p < 0.003) and showed worse outcomes in terms of Glasgow outcome score (GOS) at 6 months follow-up than those without hydrocephalus. The mean score of the MLH group was 1.67 (SD1.23), and ULH/NLH was 2.61 (SD1.4) at p < 0.008.ConclusionMultiloculated hydrocephalus is common in patients receiving delayed intraventricular administration of Colistin and required a longer duration on intraventricular Colistin to treat the pyogenic ventriculitis caused by multidrug/extensive drug-resistant A. baumannii and K. pneumoniae. It is associated with worse clinical outcomes.