{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T04:47:20Z","timestamp":1791521240350,"version":"4.3.4"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,5,3]],"date-time":"2022-05-03T00:00:00Z","timestamp":1651536000000},"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. Surg."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Hydrocephalus is common after ventriculitis. This study explores hydrocephalus's clinical characteristics following pyogenic ventriculitis due to multidrug-resistant and extensively drug-resistant <jats:italic>Acinetobacter baumannii<\/jats:italic> and <jats:italic>Klebsiella pneumoniae<\/jats:italic>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and Methods<\/jats:title><jats:p>We retrospectively reviewed patients with post-neurosurgical pyogenic ventriculitis due to multidrug-resistant and extensively drug-resistant <jats:italic>A. baumannii<\/jats:italic> and <jats:italic>K. pneumoniae<\/jats:italic> 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 48 cases were included in this study, and 25% were female. The median age was 45 (SD \u00b1 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 (<jats:italic>p<\/jats:italic> &amp;lt; 0.022). They had (32 days) longer intraventricular Colistin (<jats:italic>p<\/jats:italic> &amp;lt; 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 <jats:italic>p<\/jats:italic> &amp;lt; 0.008.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Multiloculated 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 <jats:italic>A. baumannii<\/jats:italic> and <jats:italic>K. pneumoniae<\/jats:italic>. It is associated with worse clinical outcomes.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2022.854627","type":"journal-article","created":{"date-parts":[[2022,5,3]],"date-time":"2022-05-03T05:20:53Z","timestamp":1651555253000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":11,"title":["Clinical Characteristics of Hydrocephalus Following the Treatment of Pyogenic Ventriculitis Caused by Multi\/Extensive Drug-Resistant Gram-Negative Bacilli, Acinetobacter Baumannii, and Klebsiella Pneumoniae"],"prefix":"10.3389","volume":"9","author":[{"given":"Sajan","family":"Pandey","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pei Wen","family":"Yao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhouqi","family":"Qian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Ji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ke","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,5,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1381","DOI":"10.1136\/jnnp.2008.165357","article-title":"Prospective surveillance of drain associated meningitis\/ventriculitis in a neurosurgery and neurological intensive care unit","volume":"80","author":"Scheithauer","year":"2009","journal-title":"J Neurol Neurosurg Psychiatry."},{"key":"B2","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1227\/01.NEU.0000220477.47323.92","article-title":"Risk factors for adult nosocomial meningitis after craniotomy: role of antibiotic prophylaxis","volume":"59","author":"Korinek","year":"2006","journal-title":"Neurosurgery."},{"key":"B3","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1227\/01.NEU.0000249266.26322.25","article-title":"Risk factors associated with postcraniotomy meningitis","volume":"60","author":"Kourbeti","year":"2007","journal-title":"Neurosurgery."},{"key":"B4","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1056\/nejm198403013100903","article-title":"Ventriculostomy-Related Infections","volume":"310","author":"Mayhall","year":"1984","journal-title":"N Engl J Med."},{"key":"B5","doi-asserted-by":"publisher","first-page":"229","DOI":"10.3171\/jns.2005.102.2.0229","article-title":"Bacterial meningitis caused by the use of ventricular or lumbar cerebrospinal fluid catheters","volume":"102","author":"Schade","year":"2005","journal-title":"J Neurosurg."},{"key":"B6","doi-asserted-by":"publisher","first-page":"101","DOI":"10.3171\/jns.2006.104.1.101","article-title":"Lack of value of routine analysis of cerebrospinal fluid for prediction and diagnosis of external drainage-related bacterial meningitis","volume":"104","author":"Schade","year":"2006","journal-title":"J Neurosurg."},{"key":"B7","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1093\/jac\/dkm181","article-title":"Acinetobacter baumannii meningitis in post-neurosurgical patients: clinical outcome and impact of carbapenem resistance [17]","volume":"60","author":"Metan","year":"2007","journal-title":"J Antimicrob Chemother."},{"key":"B8","doi-asserted-by":"publisher","first-page":"e34","DOI":"10.1093\/cid\/ciw861","article-title":"2017 Infectious 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":"B9","doi-asserted-by":"publisher","first-page":"241","DOI":"10.2147\/IDR.S186646","article-title":"Treatment of severe ventriculitis caused by extensively drug-resistant Acinetobacter baumannii by intraventricular lavage and administration of colistin","volume":"12","author":"Chen","year":"2019","journal-title":"Infect Drug Resist."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1609","DOI":"10.1007\/s00381-011-1528-4","article-title":"Multiloculated hydrocephalus","volume":"27","author":"Zuccaro","year":"2011","journal-title":"Child's Nerv Syst."},{"key":"B11","doi-asserted-by":"publisher","first-page":"2741","DOI":"10.1007\/s00381-020-04572-z","article-title":"Management of multiloculated hydrocephalus in children with emphasis on role of CT ventriculography","volume":"36","author":"Vankipuram","year":"2020","journal-title":"Childs Nerv Syst."},{"key":"B12","doi-asserted-by":"publisher","first-page":"348","DOI":"10.3171\/jns.1972.36.3.0348","article-title":"Conversion of multilocular hydrocephalus to unilocular","volume":"36","author":"Rhoton","year":"1972","journal-title":"Case report. J Neurosurg."},{"key":"B13","doi-asserted-by":"publisher","first-page":"106281","DOI":"10.1016\/J.IJANTIMICAG.2021.106281","article-title":"Pharmacokinetics of colistin in cerebrospinal fluid after intraventricular administration alone in intracranial infections","volume":"57","author":"Ni","year":"2021","journal-title":"Int J Antimicrob Agents."},{"key":"B14","doi-asserted-by":"publisher","first-page":"480","DOI":"10.1016\/S0140-6736(75)92830-5","article-title":"Assessment of outcome after severe brain damage: a practical scale","volume":"305","author":"Jennett","year":"1975","journal-title":"Lancet."},{"key":"B15","doi-asserted-by":"publisher","first-page":"e572","DOI":"10.1016\/j.ijid.2009.06.032","article-title":"Post-neurosurgical multidrug-resistant Acinetobacter baumannii meningitis successfully treated with intrathecal colistin. A new case and a systematic review of the literature","volume":"14","author":"Cascio","year":"2010","journal-title":"Int J Infect Dis."},{"key":"B16","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1016\/s1413-8670(10)70090-8","article-title":"Mortality rate in patients with nosocomial acinetobacter meningitis from a Brazilian hospital","volume":"14","author":"Tuon","year":"2010","journal-title":"Brazilian J Infect Dis."},{"key":"B17","doi-asserted-by":"publisher","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","author":"Pandey","year":"2019","journal-title":"Front Neurol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"547","DOI":"10.3171\/jns.1980.52.4.0547","article-title":"Compartmentalization of the cerebral ventricles as a sequela of neonatal meningitis","volume":"52","author":"Kalsbeck","year":"1980","journal-title":"J Neurosurg."},{"key":"B19","doi-asserted-by":"publisher","first-page":"357","DOI":"10.3171\/jns.1985.62.3.0357","article-title":"Isolated ventricles following intraventricular hemorrhage","volume":"62","author":"Eller","year":"1985","journal-title":"J Neurosurg."},{"key":"B20","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1007\/978-3-642-66959-0_11","article-title":"Postmeningitic hydrocephalus in infancy ventriculography with special reference to ventricular septa","volume":"16","author":"Handler","year":"1978","journal-title":"Proc XI Symp Neuroradiol."},{"key":"B21","doi-asserted-by":"publisher","first-page":"714","DOI":"10.1007\/BF01411477","article-title":"Multiloculated hydrocephalus related to cerebrospinal fluid shunt infection","volume":"138","author":"Jamjoom","year":"1996","journal-title":"Acta Neurochir (Wien)."},{"key":"B22","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1007\/s00381-014-2596-z","article-title":"Surgical management of complex multiloculated hydrocephalus in infants and children","volume":"31","author":"Akbari","year":"2015","journal-title":"Child's Nerv Syst."},{"key":"B23","doi-asserted-by":"publisher","first-page":"217","DOI":"10.3171\/PED\/2008\/1\/3\/217","article-title":"Endoscopic cyst fenestration in the treatment of multiloculated hydrocephalus in children","volume":"1","author":"El-Ghandour","year":"2008","journal-title":"J Neurosurg Pediatr."},{"key":"B24","doi-asserted-by":"publisher","first-page":"4907","DOI":"10.1128\/AAC.00345-09","article-title":"Penetration of colistin into cerebrospinal fluid","volume":"53","author":"Markantonis","year":"2009","journal-title":"Antimicrob Agents Chemother."},{"key":"B25","doi-asserted-by":"publisher","first-page":"620","DOI":"10.3171\/jns.1973.38.5.0620","article-title":"Intraventricular septations complicating neonatal meningitis","volume":"38","author":"Schultz","year":"1973","journal-title":"J Neurosurg."},{"key":"B26","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1016\/J.IJANTIMICAG.2013.02.006","article-title":"Intraventricular and intrathecal colistin as the last therapeutic resort for the treatment of multidrug-resistant and extensively drug-resistant Acinetobacter baumannii ventriculitis and meningitis: a literature review","volume":"41","author":"Karaiskos","year":"2013","journal-title":"Int J Antimicrob Agents."},{"key":"B27","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/S13756-018-0313-5","article-title":"Successful treatment of extensively drug-resistant Acinetobacter baumannii ventriculitis with polymyxin B and tigecycline- a case report","volume":"7","author":"Guo","year":"2018","journal-title":"Antimicrob Resist Infect Control"},{"key":"B28","doi-asserted-by":"publisher","first-page":"659","DOI":"10.1007\/s00381-003-0758-5","article-title":"Effectiveness of neuroendoscopic procedures in the treatment of complex compartmentalized hydrocephalus in children","volume":"19","author":"Nowos\u0142awska","year":"2003","journal-title":"Childs Nerv Syst."}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.854627\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,26]],"date-time":"2022-07-26T07:02:18Z","timestamp":1658818938000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.854627\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,3]]},"references-count":28,"alternative-id":["10.3389\/fsurg.2022.854627"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2022.854627","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,3]]},"article-number":"854627"}}