Fatal PML in a patient treated with compounded dimethyl fumarate with only modest lymphocytopenia

Refractory CNS infections often require intrathecal antibiotics but the safety of this practice has not been determined.We hereby describe our experience with intrathecal antibiotics in a series of patients admitted to a neurologic intensive care unit at a university center. Methods: Retrospective case series of all patients with refractory CNS infections admitted to a neurosciences ICU at a university hospital over 7 years. The following data were abstracted from the medical records: demographics, diagnosis, type of infection, organism, antibiotic used, time to negative cultures, and complications associatedwith intrathecal antibiotics. Results: A total of 26 patients were treated 12 (44%) male. Median age was 54 years old. The most common diagnosis was subarachnoid hemorrhage in 10/26 (38%), followed by brain tumors 6/26 (23%), intracranial hemorrhage 3/26 (12%), shunt infection 3/26 (12%), traumatic brain injury 2/26 (7%), primary meningitis and cerebral cyst 1/26 (4%) each. The most common organisms were gram negatives in 14 /26 (54%, gram positives in 6 /26 (23%), and coagulase negative staphylococcus in 6/26 (23%). The median time to CSF culture sterility was 8 days (range1-14). The antibiotics used were vancomycin in 10/26 (38%), gentamicin in 15/26 (58%), and amikacin in 1/26 (4%). No immediate complications occurred. Conclusions: Intra-thecal administration of antibiotics in patients with refractory CNS infections appears to be safe and appears to be effective at achieving CSF sterility.