Postspinal Surgery Hydrocephalus, Intraventricular Hemorrhage, and Multidrug-Resistant Ventriculitis: A Fatal Cascade

Abstract Hydrocephalus, intraventricular hemorrhage (IVH), and ventriculitis are rare but devastating complications following spinal surgery. Their coexistence significantly worsens prognosis, especially when multidrug-resistant pathogens are involved. A 59-year-old man with a C7 fracture and complete paraplegia underwent anterior and posterior cervical spine surgeries complicated by cerebrospinal fluid (CSF) leakage. He later developed hydrocephalus and IVH, requiring external ventricular drainage. Shortly thereafter, fever and altered consciousness occurred, and pus was observed in the drain. CSF analysis confirmed carbapenem-resistant Enterobacteriaceae (CRE) ventriculitis, specifically caused by Escherichia coli. Treatment with intravenous meropenem, vancomycin, and escalation to intrathecal colistin and tigecycline achieved microbiological clearance. Despite this, neurological recovery was poor, and the patient succumbed 27 days after readmission. This report emphasizes the interplay of mechanical and infectious complications after spinal surgery, highlighting the need for early recognition, aggressive combined therapy, and preventive strategies to improve outcomes.