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Ommaya reservoir-related infections: Clinical manifestations and treatment outcomes

Authors
  • Szvalb, Ariel D.
  • Raad, Issam I.
  • Weinberg, Jeffrey S.
  • Suki, Dima
  • Mayer, Rory
  • Viola, George M.1, 2, 3, 1, 4, 5, 3
  • 1 Department of Infectious Diseases
  • 2 Infection Control and Employee Health
  • 3 The University of Texas MD Anderson Cancer Center
  • 4 Baylor College of Medicine, Houston, TX
  • 5 Department of Neurosurgery
Type
Published Article
Journal
Journal of Infection
Publisher
Elsevier
Publication Date
Jan 01, 2013
Accepted Date
Dec 11, 2013
Volume
68
Issue
3
Pages
216–224
Identifiers
DOI: 10.1016/j.jinf.2013.12.002
Source
Elsevier
Keywords
License
Unknown

Abstract

ObjectivesAs infection is a severe complication of Ommaya reservoirs (OR), and existing data is limited, herein we describe the largest study of the clinical manifestations and treatment outcomes of Ommaya reservoir-related infections (ORRI). MethodsWe retrospectively reviewed the records of all patients at our institution who had an OR placed, and developed a definite device-related infection between 2001 and 2011. ResultsAmong 501 OR placements, 40 patients (8%) developed an ORRI. These presented with meningitis and/or meningoencephalitis (60%), cellulitis (20%), or a combination thereof (20%). Approximately 40% occurred ≤30 days of OR placement, while 60% occurred ≤10 days after the device was last accessed. Only 20% presented with leukocytosis, while another 18% had a normal cerebrospinal fluid (CSF). Gram-positive skin flora accounted >80% of the pathogens. The median hospital stay and duration of antibiotics were 13 and 24 days, respectively. Although mortality rates (≈10%) were similar among all treatment groups (p > 0.99), shorter hospitalization and antimicrobial treatment durations were obtained with early versus late device removal (p < 0.038). ConclusionsAs clinical symptoms can be non-specific and CSF parameters may be within normal limits, a high suspicion for infection is required. The shortest hospitalization and treatment course was achieved with early device removal.

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