ArticleNeurosurgical review2026
Intraventricular colistin for multidrug-resistant ventriculitis: the final therapeutic option?
Article in Neurosurgical review, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
To evaluate the efficacy and safety of intraventricular (IVT) colistin in combination with intravenous therapy for the treatment of multidrug-resistant (MDR) ventriculitis following neurosurgical procedures, and to determine optimal treatment duration and outcomes in the largest single-centre series to date. This retrospective study analysed 46 patients with culture-proven MDR ventriculitis treated at a tertiary care neurosurgical centre between January 2023 and December 2024. All pathogens had a colistin MIC of ≤ 2 µg/mL. IVT colistin (10 mg colistimethate sodium) was administered via external ventricular drain (EVD) for variable durations. Outcomes were compared between patients receiving IVT plus intravenous colistin for ≥ 10 days versus those receiving shorter courses and intravenous colistin alone. The primary outcome was clinical cure; secondary endpoints included infection control timing, mortality, and adverse events. Infection was controlled in 63.6% of cases, with a median time to CSF sterilisation of 7.5 days. Patients receiving IVT and intravenous colistin for ≥ 10 days had significantly higher infection control rates (94% vs. 37%, p = 0.001), lower overall mortality (45% vs. 75%, p = 0.013), and reduced infection-attributable mortality (18.8% vs. 56.3%, p = 0.028) when compared to combined treatment given for less than 10 days. Combined treatment also had better infection control when compared with those that received only intravenous colistin (94% vs. 58%, p = 0.024). The most frequently isolated organism was Acinetobacter baumannii (50%). Adverse effects were limited to acute kidney injury in 4 patients (8.7%), with no neurotoxicity reported. IVT colistin appears to be a safe and effective adjunct to systemic therapy in MDR ventriculitis, particularly when administered for ≥ 10 days. It significantly improves infection control and may reduce infection-related mortality. Given its low neurotoxicity and favourable outcomes in appropriately selected patients, IVT colistin should be considered a cornerstone in managing MDR gram-negative ventriculitis. Prospective multicenter studies are needed to establish standardised treatment protocols.
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