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Open Access 01-12-2024 | Central Nervous System Trauma | Original Article

Ventriculostomy-associated infection (VAI) in patients with acute brain injury—a retrospective study

Authors: Pernille Nielsen, Markus Harboe Olsen, Rasmus Stanley Willer-Hansen, John Hauerberg, Helle Krogh Johansen, Aase Bengaard Andersen, Jenny Dahl Knudsen, Kirsten Møller

Published in: Acta Neurochirurgica | Issue 1/2024

Abstract

Background

Ventriculostomy-associated infection (VAI) is common after external ventricular drains (EVD) insertion but is difficult to diagnose in patients with acute brain injury. Previously, we proposed a set of criteria for ruling out VAI in traumatic brain injury. This study aimed to validate these criteria. For exploratory purposes, we sought to develop and validate a score for VAI risk assessment in patients with different types of severe acute brain injury.

Methods

This retrospective cohort study included adults with acute brain injury who received an EVD and in whom CSF samples were taken over a period of 57 months. As standard non-coated bolt-connected EVDs were used. The predictive performance of biomarkers was analyzed as defined previously. A multivariable regression model was performed with five variables.

Results

A total of 683 patients with acute brain injury underwent EVD placement and had 1272 CSF samples; 92 (13.5%) patients were categorized as culture-positive VAI, 130 (19%) as culture-negative VAI, and 461 (67.5%) as no VAI. A low CSF WBC/RBC ratio (< 0.037), high CSF/plasma glucose ratio (> 0.6), and low CSF protein (< 0.5g/L) showed a positive predictive value of 0.09 (95%CI, 0.05–0.13). In the multivariable logistic regression model, days to sample (OR 1.09; 95%CI, 1.03–1.16) and CSF WBC/RBC ratio (OR 34.86; 95%CI, 3.94–683.15) were found to predict VAI.

Conclusion

In patients with acute brain injury and an EVD, our proposed combined cut-off for ruling out VAI performed satisfactorily. Days to sample and CSF WBC/RBC ratio were found independent predictors for VAI in the multivariable logistic regression model.

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Title: Ventriculostomy-associated infection (VAI) in patients with acute brain injury—a retrospective study
Authors: Pernille Nielsen
Markus Harboe Olsen
Rasmus Stanley Willer-Hansen
John Hauerberg
Helle Krogh Johansen
Aase Bengaard Andersen
Jenny Dahl Knudsen
Kirsten Møller
Publication date: 01-12-2024
Publisher: Springer Vienna
Keyword: Central Nervous System Trauma
Published in: Acta Neurochirurgica / Issue 1/2024
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-024-06018-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Ventriculostomy-associated infection (VAI) in patients with acute brain injury—a retrospective study

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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