1426. Ommaya Reservoir-Related Infections: Clinical Manifestations and Treatment Outcomes
Session: Poster Abstract Session: CNS Infections
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Ommaya Reservoir-Related Infections - Clinical Manifestations and Treatment Outcomes.pdf (550.1 kB)
  • Background: Infection is a severe complication of Ommaya reservoirs. However, data on the clinical presentation of and therapeutic approach for such infections are limited. Herein we describe the largest study of the clinical manifestations and treatment outcomes of Ommaya reservoir-related infections.

    Methods: We retrospectively reviewed the hospital records of all patients at MD Anderson Cancer Center, between 2001 and 2011, who had an Ommaya reservoir placement and a definite device-related infection.

    Results: Among 501 Ommaya reservoir placements, 40 patients (8%) had a device-related infection. The mean patient age was 45±17.9 years. The most frequent clinical manifestations of infection were headaches (83%), fever (68%), meningismus (40%), and wound drainage (23%). The median time from reservoir placement to infection was 41 days (Q1-Q3=15.5-142.5). Approximately 40% of the infections developed within 30 days of device placement, whereas 60% did so within 10 days after the device was last accessed. Only 20% of the patients presented with leukocytosis, while 21% had all cerebrospinal fluid (CSF) parameters within normal limits (leukocytes, glucose, and protein levels). Gram-positive skin flora accounted for more than 80% of the pathogens. The median hospital stay and antibiotic therapy duration were 13 and 24 days, respectively. The treatment strategy for 22 of the 40 patients was early removal of the Ommaya reservoir (median=3; Q1-Q3=1-5 days from admission). In the remaining 18 patients, the strategy was to keep the reservoir in place and treat the infection solely with antimicrobials. This approach was successful for only 9 of the 18 patients. In the remaining 9 patients, due to the lack of clinical response, the reservoir was removed at a median of 14 days (Q1-Q3=10-20). The most cost-effective therapeutic approach was early versus late removal of the reservoir (p<.038). The overall mortality rate was 10%.

    Conclusion: Most Ommaya reservoir-related infections develop soon after placement or last access. As clinical symptoms are usually mild and nonspecific and because CSF parameters may be normal, a high suspicion for infection is required. Although mortality rates were similar among all groups (p>.99), shorter hospitalization and antimicrobial treatment durations were obtained with early device removal.

    Ariel D. Szvalb, MD1, Jeffrey Weinberg, MD2, Dima Suki, PhD2, Rory Mayer, MD3 and George M. Viola, MD, MPH4, (1)Infectious Diseases, Baylor College of Medicine, Houston, TX, (2)Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, (3)Neurosurgery, Baylor College of Medicine, Houston, TX, (4)Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, TX

    Disclosures:

    A. D. Szvalb, None

    J. Weinberg, None

    D. Suki, None

    R. Mayer, None

    G. M. Viola, None

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