Increased ventriculostomy infection rate with use of intraventricular tissue plasminogen activator: a single-center observation

Abstract

Objective: Intraventricular tissue plasminogen activator (alteplase) has been advocated for prevention of vasospasm in aneurysmal subarachnoid hemorrhage and treatment of traumatic or spontaneous intraventricular hemorrhage. External ventricular drain (EVD) insertion is often performed to manage increased intracranial pressure and hydrocephalus associated with these disease states. EVD-related ventriculitis is a serious infection with an up to 50% mortality rate.

Methods: We assessed the EVD infection rate in patients receiving intraventricular alteplase over a 12-month period. Patients were divided into intraventricular alteplase and non-intraventricular alteplase groups; ventriculitis rates were compared.

Results: EVDs were placed in 93 patients. Six of 7 (86%) patients who received intraventricular alteplase developed ventriculitis versus 4 of 86 (5%) patients in the non-intraventricular alteplase group (p<0.0001).

Conclusion: Intraventricular alteplase use may increase ventriculitis risk. Currently, we reserve intraventricular alteplase for patients with EVDs obstructed by hematoma accompanied by increased intracranial pressure.

Keywords: CLEAR III; CSF; Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage Phase III; EVD; External ventricular drain; Infection; Intraventricular; Ventriculitis; Ventriculostomy; cerebrospinal fluid; external ventricular drain; tPA; tissue plasminogen activator.