Neurosurgery 98:643–650, 2026
This clinical cohort study evaluates prophylactic intraventricular vancomycin (10 mg added to each intraventricular chemotherapy cycle) to prevent Ommaya reservoir–associated bacterial meningitis in patients with leptomeningeal disease. Over 501 treatments in 63 patients, infection rate was 0% versus 10.25% in a 5-year historical control, with no observed vancomycin toxicity and substantial cost savings.
The manuscript details methods, statistical analyses, safety monitoring, limitations inherent to a historical-control design, and a meta-analytic context of prior infection rates. Authors conclude prophylactic intraventricular vancomycin eliminated infections in their cohort and recommend consideration of broader adoption and prospective randomized trials.
Prophylactic intraventricular vancomycin: Adding 10 mg of intraventricular vancomycin to each cycle of planned intrathecal chemotherapy through an Ommaya reservoir (OmR) in patients with leptomeningeal disease eliminated OmR-associated bacterial meningitis infections over a 12-month period (0% infection rate in 63 patients, 501 treatments).
Historical infection rates: Prior to vancomycin prophylaxis, OmR-associated infection rates were 10.25% per patient and 1.71% per treatment in a 5-year historical control group (322 patients, 1932 treatments).
Absolute risk reduction and NNT: The absolute risk reduction for OmR-associated infection was 10.3% (P = .0028), with a number needed to treat (NNT) of 10 to prevent one infection.
No observed toxicity or resistance: No vancomycin-associated toxicity or development of antibiotic-resistant infections was observed during the study period, even with repeated dosing.
Significant cost savings: Prophylactic vancomycin cost $10 per dose, with an estimated annual savings of over $600,000 by preventing infections and associated treatments, not including potential additional savings from avoiding reservoir removal and replacement.
Robust methodology: The intervention was implemented as a global practice change, with prospective data collection for the vancomycin cohort and comparison to a well-matched historical control group, though some differences in tumor type and number of treatments existed.
Clinical and practical implications: The findings support strong consideration of prophylactic intraventricular vancomycin in OmR-based chemotherapy regimens, with the potential to significantly improve patient outcomes and reduce healthcare costs.
Need for further research: Prospective randomized trials are recommended to confirm these results and establish optimal dosing and broader applicability.
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