{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T05:34:09Z","timestamp":1791264849531,"version":"4.1.0"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,4,26]],"date-time":"2024-04-26T00:00:00Z","timestamp":1714089600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Nosocomial infectious ventriculitis caused by multidrug-resistant (MDR) Gram-negative bacilli associated with external ventricular drainage (EVD) placement poses a significant mortality burden and hospital costs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>This study aims to analyze the characteristics, ventriculitis evolution, treatment, and outcomes of patients with ventriculitis due to MDR Gram-negative bacilli associated with EVD placement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective cohort study focusing on patients with nosocomial infection caused by MDR Gram-negative bacilli while on EVD was conducted from 2019 to 2022. Medical, laboratory, and microbiological records were collected. The antibiotic resistance of the Gram-negative bacilli isolated in the cerebrospinal fluid (CSF) of patients was analyzed. The risk factors were identified using univariate risk models and were analyzed using survival curves (Cox regression). An adjusted Cox proportional hazards model was also constructed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 530 patients with suspected EVD-associated ventriculitis, 64 patients with isolation of Gram-negative bacilli in CSF were included. The estimated mortality was 78.12%. Hemorrhages (intracranial, subarachnoid, and intraventricular) were observed in 69.8% of patients. <jats:italic>Acinetobacter baumannii, Klebsiella pneumoniae<\/jats:italic>, and <jats:italic>Pseudomonas aeruginosa<\/jats:italic> were the most frequently isolated bacilli. In the univariate analysis, significant risk factors for mortality included arterial hypertension, a Glasgow Coma Scale (GCS) score of \u2264 8, invasive mechanical ventilation (IMV) upon hospital admission and during hospitalization, septic shock, and ineffective treatment. The adjusted Cox proportional hazards model revealed that septic shock (HR = 3.3, 95% CI = 1.5\u20137.2; <jats:italic>p<\/jats:italic> = 0.003) and ineffective treatment (HR = 3.2, 1.6\u20136.5, 0.001) were significant predictors. A high resistance to carbapenems was found for <jats:italic>A. baumannii<\/jats:italic> (91.3%) and <jats:italic>P. aeruginosa<\/jats:italic> (80.0%). Low resistance to colistin was found for <jats:italic>A. baumannii<\/jats:italic> (4.8%) and <jats:italic>P. aeruginosa<\/jats:italic> (12.5%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Ineffective treatment was an independent hazard factor for death in patients with ventriculitis caused by MDR Gram-negative bacilli associated with EVD.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2024.1384206","type":"journal-article","created":{"date-parts":[[2024,4,26]],"date-time":"2024-04-26T04:48:54Z","timestamp":1714106934000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":12,"title":["Ventriculitis due to multidrug-resistant gram-negative bacilli associated with external ventricular drain: evolution, treatment, and outcomes"],"prefix":"10.3389","volume":"15","author":[{"given":"Ana Luisa","family":"Corona-Nakamura","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martha Judith","family":"Arias-Merino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleazar Iv\u00e1n","family":"\u00c1vila-Esparza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda de Lourdes","family":"Tolentino-Corona","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9sar Cuauht\u00e9moc","family":"Ca\u00f1edo-Casta\u00f1eda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H\u00e9ctor Enrique","family":"Flores-Salinas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Fernando","family":"Corona-Mac\u00edas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martha Elena","family":"V\u00e1zquez-Arias","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,4,26]]},"reference":[{"key":"B1","unstructured":"Antimicrobial Resistance - World Health Organization"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e34","DOI":"10.1093\/cid\/ciw861","article-title":"Diseases society of America's clinical practice guidelines for healthcare-associated ventriculitis and meningitis","volume":"64","author":"Tunkel","year":"2017","journal-title":"Clin Infect Dis"},{"key":"B3","doi-asserted-by":"publisher","first-page":"621","DOI":"10.1016\/j.cmi.2017.05.013","article-title":"Management of post-neurosurgical meningitis: narrative review","volume":"23","author":"Hussein","year":"2017","journal-title":"Clin Microbiol Infect."},{"key":"B4","doi-asserted-by":"publisher","first-page":"FOCUS17443","DOI":"10.3171\/2017.8.FOCUS17443","article-title":"The 21st-century challenge to neurocritical care: the rise of the superbug Acinetobacter baumannii. A meta-analysis of the role of intrathecal or intraventricular antimicrobial therapy in reduction of mortality","volume":"43","author":"Mohammed","year":"2017","journal-title":"Neurosurg Focus"},{"key":"B5","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1080\/14787210.2020.1717949","article-title":"Bacterial external ventricular catheter-associated infection","volume":"18","author":"Dorresteijn","year":"2020","journal-title":"Expert Rev Anti Infect Ther."},{"key":"B6","doi-asserted-by":"publisher","first-page":"993","DOI":"10.1080\/14787210.2021.1866544","article-title":"Healthcare-associated ventriculitis: current and emerging diagnostic and treatment strategies","volume":"19","author":"Hasbun","year":"2021","journal-title":"Expert Rev Anti Infect Ther."},{"key":"B7","doi-asserted-by":"publisher","first-page":"e89","DOI":"10.1016\/j.wneu.2021.02.087","article-title":"Decreasing external ventricular drain infection rates in the neurocritical care unit: 12-year longitudinal experience at a single institution","volume":"150","author":"Walek","year":"2021","journal-title":"World Neurosurg."},{"key":"B8","first-page":"397","article-title":"Infecciones nosocomiales en un hospital de pacientes neurol\u00f3gicos, an\u00e1lisis de 10 a\u00f1os [Nosocomial infections at a neurologic hospital, analysis of 10 years]","volume":"138","author":"Soto-Hern\u00e1ndez","year":"2002","journal-title":"Gac Med Mex."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1218","DOI":"10.3171\/2020.2.JNS192051","article-title":"Predictors of ventriculostomy infection in a large single-center cohort","volume":"134","author":"Sweid","year":"2020","journal-title":"J Neurosurg"},{"key":"B10","doi-asserted-by":"publisher","first-page":"293","DOI":"10.3892\/etm.2023.11992","article-title":"Outcomes in meningitis-ventriculitis treated with intravenous or intrathecal plus intravenous colistin: A meta-analysis","volume":"25","author":"Georgakopoulou","year":"2023","journal-title":"Exp Ther Med"},{"key":"B11","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1016\/j.eimce.2020.12.005","article-title":"Cerebrospinal fluid drainage-related ventriculitis due to multidrug-resistant microorganisms","volume":"40","author":"Solo-Peleteiro","year":"2022","journal-title":"Enferm Infecc Microbiol Clin."},{"key":"B12","doi-asserted-by":"publisher","first-page":"697","DOI":"10.2147\/IDR.S326456","article-title":"Current Perspectives on the diagnosis and management of healthcare-associated ventriculitis and meningitis","volume":"15","author":"Karvouniaris","year":"2022","journal-title":"Infect Drug Resist"},{"key":"B13","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1111\/j.1469-0691.2011.03570.x","article-title":"Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance","volume":"18","author":"Magiorakos","year":"2012","journal-title":"Clin Microbiol Infect"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1174","DOI":"10.3389\/fneur.2018.01174","article-title":"Outcome following the treatment of ventriculitis caused by multi\/extensive drug resistance gram negative bacilli; Acinetobacter baumannii and Klebsiella pneumonia","volume":"9","author":"Pandey","year":"2019","journal-title":"Front Neurol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"e523","DOI":"10.1093\/cid\/ciaa121","article-title":"Clinical and laboratory standards institute and European committee on antimicrobial susceptibility testing position statements on polymyxin B and colistin clinical breakpoints","volume":"71","author":"Satlin","year":"2020","journal-title":"Clin Infect Dis."},{"key":"B16","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1590\/S1413-86702010000500003","article-title":"Mortality rate in patients with nosocomial Acinetobacter meningitis from a Brazilian hospital","volume":"14","author":"Tuon","year":"2010","journal-title":"Braz J Infect Dis."},{"key":"B17","doi-asserted-by":"publisher","first-page":"2020","DOI":"10.3390\/microorganisms11082020","article-title":"Multidrug-resistant and extensively drug-resistant Acinetobacter baumannii causing nosocomial meningitis in the neurological intensive care unit","volume":"11","author":"Fursova","year":"2023","journal-title":"Microorganisms"},{"key":"B18","doi-asserted-by":"publisher","first-page":"964","DOI":"10.1212\/WNL.0000000000008552","article-title":"Factors and measures predicting external CSF drain-associated ventriculitis: a review and meta-analysis","volume":"93","author":"Dorresteijn","year":"2019","journal-title":"Neurology."},{"key":"B19","doi-asserted-by":"publisher","first-page":"734156","DOI":"10.3389\/fneur.2021.734156","article-title":"Risk factors promoting external ventricular drain infections in adult neurosurgical patients at the intensive care unit-a retrospective study","volume":"12","author":"Khalaveh","year":"2021","journal-title":"Front Neurol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1186\/s12941-023-00612-z","article-title":"External ventriculostomy-associated infection reduction after updating a care bundle","volume":"22","author":"Rojas-Lora","year":"2023","journal-title":"Ann Clin Microbiol Antimicrob"},{"key":"B21","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1007\/s00701-019-03801-y","article-title":"Risk factors for meningitis in neurosurgical patients with cerebrospinal fluid drains: prospective observational cohort study","volume":"161","author":"Hussein","year":"2019","journal-title":"Acta Neurochir."},{"key":"B22","doi-asserted-by":"publisher","first-page":"230","DOI":"10.24875\/CIRU.18000052","article-title":"Ventriculitis associated with extraventricular drainage: etiology, diagnosis and treatment focused on neurocritic care units. Ventriculitis asociada a drenaje extraventricular: etiolog\u00eda, diagn\u00f3stico y tratamiento enfocado a unidades de cuidados neurocr\u00edticos","volume":"87","author":"Ulloque-Caama\u00f1o","year":"2019","journal-title":"Cir Cir."},{"key":"B23","doi-asserted-by":"publisher","first-page":"e0025322","DOI":"10.1128\/spectrum.00253-22","article-title":"Carbapenem-resistant gram-negative bacteria-related healthcare-associated ventriculitis and meningitis: antimicrobial resistance of the pathogens, treatment, and outcome","volume":"10","author":"Ye","year":"2022","journal-title":"Microbiol Spectr."},{"key":"B24","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1007\/s00701-016-2702-y","article-title":"Outcomes in meningitis\/ventriculitis treated with intravenous or intraventricular plus intravenous colistin","volume":"158","author":"Fotakopoulos","year":"2016","journal-title":"Acta Neurochir."},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.3171\/2019.5.FOCUS19278","article-title":"Outcome following postneurosurgical Acinetobacter meningitis: an institutional experience of 72 cases","author":"Sharma","year":"2019","journal-title":"Neurosurg Focus"},{"key":"B26","doi-asserted-by":"publisher","first-page":"420","DOI":"10.3390\/idr14030045","article-title":"Etiology and outcomes of healthcare-associated meningitis and ventriculitis-a single center cohort study","volume":"14","author":"Panic","year":"2022","journal-title":"Infect Dis Rep"},{"key":"B27","first-page":"804","article-title":"Evaluation of post-operative meningitis: comparison of meningitis caused by Acinetobacter spp","volume":"29","author":"Senturk","year":"2019","journal-title":"and Other Possible Causes Turk Neurosurg."},{"key":"B28","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1016\/j.cmi.2021.11.025","article-title":"European society of clinical microbiology and infectious diseases (ESCMID) guidelines for the treatment of infections caused by multidrug-resistant Gram-negative bacilli (endorsed by European society of intensive care medicine)","volume":"28","author":"Paul","year":"2022","journal-title":"Clin Microbiol Infect."},{"key":"B29","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1016\/j.jcrc.2018.07.025","article-title":"Intraventricular CNS treatment with colistin-tigecycline combination: a case series","volume":"47","author":"Tsolaki","year":"2018","journal-title":"J Crit Care."},{"key":"B30","doi-asserted-by":"publisher","first-page":"103","DOI":"10.53854\/liim-3101-14","article-title":"Successful treatment of pan-drug resistant Acinetobacter baumannii nosocomial meningitis\/ventriculitis by combined intravenous and intrathecal colistin-tigecycline administration: a case series","volume":"31","author":"Theofanopoulos","year":"2023","journal-title":"Infez Med."},{"key":"B31","doi-asserted-by":"publisher","first-page":"ofad507","DOI":"10.1093\/ofid\/ofad507","article-title":"Utilizing ceftazidime\/avibactam therapeutic drug monitoring in the treatment of neurosurgical meningitis caused by difficult-to-treat resistant Pseudomonas aeruginosa and KPC-Producing Enterobacterales","volume":"10","author":"Yasmin","year":"2023","journal-title":"Open Forum Infect Dis"},{"key":"B32","first-page":"1","article-title":"Difusi\u00f3n de los antibi\u00f3ticos en el sistema nervioso central [Antibiotic diffusion to central nervous system]","volume":"31","author":"Cabrera-Maqueda","year":"2018","journal-title":"Rev Esp Quimioter."},{"key":"B33","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1080\/14787210.2022.2020099","article-title":"All-cause mortality rates in adults with carbapenem-resistant Gram-negative bacterial infections: a comprehensive review of pathogen-focused, prospective, randomized, interventional clinical studies","volume":"20","author":"Lodise","year":"2022","journal-title":"Expert Rev Anti Infect Ther."}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2024.1384206\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,26]],"date-time":"2024-04-26T04:48:59Z","timestamp":1714106939000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2024.1384206\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,26]]},"references-count":33,"alternative-id":["10.3389\/fneur.2024.1384206"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2024.1384206","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,26]]},"article-number":"1384206"}}