Challenges in Diagnosis and Treatment of Neonatal Ventriculitis: A Case Report and Systematic Review of Difficult-to-Treat Central Nervous System Infection Resistant to Conventional Therapy


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Ongun H., Kihtir Z., Zarif N. O., Koyuncu Özyurt Ö., Kara T. T., Çelik K., ...More

Journal of Pediatric Infectious Diseases, vol.19, no.3, pp.127-139, 2024 (SCI-Expanded) identifier

  • Publication Type: Article / Review
  • Volume: 19 Issue: 3
  • Publication Date: 2024
  • Doi Number: 10.1055/s-0043-1778121
  • Journal Name: Journal of Pediatric Infectious Diseases
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, CAB Abstracts, Veterinary Science Database
  • Page Numbers: pp.127-139
  • Keywords: central nervous system infection, intraventricular treatment, preterm neonate, tigecycline
  • Akdeniz University Affiliated: Yes

Abstract

Objective Ventriculitis is an example of the increasing global trend in difficult-to-treat infections in neonates caused by pathogens resistant to conventional therapies. This article describes the first use of intravenous and intraventricular tigecycline to treat ventriculitis caused by vancomycin-resistant enterococci in a preterm neonate and systematically review the literature on challenges posed by the definitions, diagnosis, and treatment of neonatal ventriculitis Methods The authors searched PubMed and Internet search engines for ventriculitis in the period from 2003 to 2023 restricting the research to Newborn, Human, English language, and full-text availability. Results Thirty-seven publications (20 case reports, 6 case series, and 11 research articles) were extracted upon research. Preterm birth, posthemorrhagic ventricular dilatation requiring placement of ventricular access devices, and sepsis preceded neonatal ventriculitis. Infections caused by rare microorganisms, in particular gram-negative bacteria resistant to conventional therapies, predominated in the publications describing the need for a combination of intravenous (IV) and intraventricular (IVT) therapies. Survivors of neonatal ventriculitis developed neurodevelopmental impairments such as hydrocephalus, seizures, motor function, hearing, and vision impairment. Conclusion Clinical suspicion of ventriculitis indicated by subtle signs is key for prompt diagnosis. Effective IV and IVT antibiotics are essential to prevent serious sequelae and mortality. The drug delivery method should be changed if there is no clinical response. This study emphasizes the urgent need for pediatric trials of antibiotics against organisms resistant to other drugs.