Ventriculitis: A Severe Complication of Central Nervous System Infections

David Luque-Paz; Matthieu Revest; François Eugène; Sarrah Boukthir; Loren Dejoies; Pierre Tattevin; Pierre-Jean Le Reste

doi:10.1093/ofid/ofab216

Ventriculitis: A Severe Complication of Central Nervous System Infections

Open Forum Infect Dis. 2021 Apr 29;8(6):ofab216. doi: 10.1093/ofid/ofab216. eCollection 2021 Jun.

Authors

David Luque-Paz^{1

2}, Matthieu Revest^{1

2

3}, François Eugène⁴, Sarrah Boukthir⁵, Loren Dejoies⁵, Pierre Tattevin^{1

2

3}, Pierre-Jean Le Reste⁶

Affiliations

¹ Infectious Diseases and Intensive Care Unit, Rennes University Hospital, Rennes, France.
² Rennes University, Inserm, Bacterial Regulatory RNAs and Medicine, UMR_S 1230, Rennes, France.
³ CIC-Inserm 1414, Rennes University Hospital, Rennes, France.
⁴ Department of Neuroradiology, Rennes University Hospital, Rennes, France.
⁵ Bacteriology Department, Rennes University Hospital, Rennes, France.
⁶ Department of Neurosurgery, Rennes University Hospital, Rennes, France.

Abstract

Background: Ventriculitis, a dreaded complication of brain abscess, meningitis, and various neurosurgical procedures, has attracted limited attention in the medical literature.

Methods: This is a retrospective, single-center study. We screened the medical files of all patients who had a brain imaging report that included the word "ventriculitis" during years 2005-2019. Only patients with clinical, microbiological, and imaging features of ventriculitis were included. Data were collected through a standardized questionnaire.

Results: Ninety-eight patients fulfilled inclusion criteria: 42 women and 56 men, and the median age was 60 years (interquartile range, 48-68). The primary mechanism for ventriculitis was classified as follows: brain abscess (n = 29, 29.6%), meningitis (n = 27, 27.6%), intraventricular catheter-related (n = 17, 17.3%), post-neurosurgery (n = 13, 13.3%), and hematogenous (n = 12, 12.2%). The main neuroimaging features were intraventricular pus (n = 81, 82.7%), ependymal enhancement (n = 70, 71.4%), and intraventricular loculations (n = 15, 15.3%). The main pathogens were streptococci (n = 44, 44.9%), Gram-negative bacilli (n = 27, 27.6%), and staphylococci (n = 15, 15.3%). In-hospital and 1-year mortality rates were 30.6% (n = 30) and 38.8% (n = 38), respectively. Neurological sequelae were reported in 34 of 55 (61.8%) survivors, including cognitive impairment (n = 11), gait disturbances (n = 9), paresis (n = 7), behavior disorder (n = 6), and epilepsy (n = 5). On multivariate analysis, age >65 years, Glasgow Coma Scale score <13 at initial presentation, status epilepticus, hydrocephalus, and positive cerebrospinal fluid culture were associated with 1-year mortality. We built a scoring system to stratify patients with ventriculitis into low risk (12.5%), intermediate risk (36.5%), and high risk (71.4%) of death.

Conclusions: Ventriculitis is a severe complication of brain abscess, meningitis, or neurosurgery, with an in-hospital mortality rate of 30% and neurological sequelae in 60% of survivors.

Keywords: brain abscess; central nervous system infections; meningitis; outcomes; ventriculitis.