Ventriculitis: A Retrospective Cohort Study of Clinical Features, Outcomes, and Device Management Practices.

Abstract Background Ventriculitis is a severe central nervous system infection, often secondary to intraventricular device use or neurosurgical procedures, with high morbidity and mortality. Diagnostic criteria remain debated and treatment strategies lack standardization. Methods We conducted a retrospective cohort study from 2014 to 2022 to describe the clinical characteristics, microbiological profile, treatment strategies, and outcomes of ventriculitis at a tertiary care center. Additionally, we compared outcomes before and after the implementation of an updated intraventricular device management protocol. Results A total of 403 positive CSF cultures were identified during the study period. Among these, 87 fulfilled clinical and microbiological criteria for ventriculitis. Healthcare-associated cases predominated (73, 83.9%), with neurosurgical interventions (72, 82.8%) and external ventricular drain use (54, 62.1%) as the most prevalent risk factors. The most common pathogens were coagulase-negative Staphylococci (42, 48.3%), particularly Staphylococcus epidermidis (33, 37.9%). Fever (56, 64.4%) and altered consciousness (40, 45.9%) were the most frequent symptoms. Attributable mortality reached 33.3% (29/87), increasing to 39.1% (34/87) within one-year post-episode. The introduction of the updated protocol may have contributed to a reduction in mortality between the study periods RR 0.45 (0.32–0.78) p=0.003. Among discharged patients, 67.3% (37/55) experienced neurological sequelae. Predictors of higher mortality included CSF protein ≥1 mg/mL at diagnosis and a Glasgow Coma Scale score ≤8 during the clinical course. Conclusions Ventriculitis remains a complex and life-threatening condition with considerable diagnostic and management challenges. Our findings suggest that standardized intraventricular device care protocols may contribute to improved outcomes, although further evaluation is needed.