Pyogenic ventriculitis

Pyogenic ventriculitis (PV) is a rare, severe, and debilitating intracranial infection due to inflammation of the ventricular ependymal lining and is associated with pus in the ventricular system 1)

This infection can lead to hydrocephalus and death if not promptly recognized and treated. PV is synonymous with pyogenic intraventricular empyema (PIE), pyogenic ependymitis, and pyocephalus.

Most cases are caused by intraventricular rupture of cerebral abscess and direct implantation of pathogens following head injury and neurosurgical procedures, e.g., ventricular drain insertion 2).

The commonest organisms causing pyogenic ventriculitis are Staphylococcus aureus, other Gram-positive cocci, Enterobacter and Klebsiella species, in association with nosocomial infection or immunosuppression 3) 4).

In the series of Wang et al., the most frequently isolated pathogen from cerebrospinal fluid (CSF) was Acinetobacter baumannii, followed by Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, and Serratia marcescens 5).

Acinetobacter baumannii is an important cause of nosocomial ventriculitis associated with external ventricular drainage (EVD) and have substantially increased over recent years 6).

see Acinetobacter baumannii ventriculitis.

1)
Jung GW, Parkins MD, Church D. Pyogenic ventriculitis complicating Aggregatibacter aphrophilus infective endocarditis: A case report and literature review. Can J Infect Dis Med Microbiol. 2009 Fall;20(3):e107-9. doi: 10.1155/2009/971735. PMID: 20808450; PMCID: PMC2770311.
2)
Humphreys H, Jenks P (2015) Surveillance and management of ventriculitis following neurosurgery. J Hosp Infect 89(4):281–286
3)
Fujikawa A, Tsuchiya K, Honya K, Nitatori T (2006) Comparison of MRI sequences to detect ventriculitis. AJR Am J Roentgenol 187(4): 1048–1053
4)
Fukui MB, Williams RL, Mudigonda S (2001) CT and MR imaging features of pyogenic ventriculitis. AJNR Am J Neuroradiol 22:1510– 1516
5)
Wang JH, Lin PC, Chou CH, Ho CM, Lin KH, Tsai CT, Wang JH, Chi CY, Ho MW. Intraventricular antimicrobial therapy in postneurosurgical Gram-negative bacillary meningitis or ventriculitis: a hospital-based retrospective study. J Microbiol Immunol Infect. 2014 Jun;47(3):204-10. doi: 10.1016/j.jmii.2012.08.028. Epub 2012 Nov 30. PubMed PMID: 23201321.
6)
Hoenigl M, Drescher M, Feierl G, Valentin T, Zarfel G, Seeber K, Krause R, Grisold A. Successful management of nosocomial ventriculitis and meningitis caused by extensively drug-resistant Acinetobacter baumannii in Austria. Can J Infect Dis Med Microbiol. 2013 Fall;24(3):e88-90. PubMed PMID: 24421838.