Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Acta Neurochirurgica
Published in: Acta Neurochirurgica 3/2016

01-03-2016 | Experimental Research - Neurosurgical Techniques

Indicators of external ventricular drainage-related infections—a retrospective observational study

Published in: Acta Neurochirurgica | Issue 3/2016

Login to get access

Abstract

Background

External ventricular drainage (EVD) is frequently used in different groups of patients in neurocritical care. Despite the frequent use of EVD, no consensus regarding the diagnosis of EVD-related infection currently exists, and diagnosis is commonly based on criteria for the diagnosis of non-EVD-related CNS infections. This study evaluates the diagnostic accuracy of clinical and laboratory parameters for the prediction of EVD-related infection in patients with proven EVD-related infection.

Methods

In two tertiary care centers, data on EVD insertions were matched with a microbiologic database of cultured microorganisms and positive Gram stains of cerebrospinal fluid (CSF) to identify patients with EVD-related infections. Available clinical data and results of blood tests and CSF analysis were retrospectively collected. Predefined potential clinical and laboratory predictors of EVD-related infection were compared between three time points: at the time EVD insertion and 48 h before and at the time of occurrence of EVD-related infection.

Results

Thirty-nine patients with EVD-associated infection defined by positive CSF culture or positive CSF Gram stains and concomitant clinical signs of infection were identified. At the time of infection, a significantly higher incidence of abnormal temperature, high respiratory rate, and a slightly but significantly higher incidence of decreased mental state were observed. The assessed blood and CSF parameters did not significantly differ between the different assessment time points.

Conclusions

Our analysis of 39 patients with culture positive EVD-related infection showed that commonly used clinical and laboratory parameters are not reliable infection predictors.
Literature
1.
2.
de Rooij NK, Linn FH, van der Plas JA, Algra A, Rinkel GJ (2007) Incidence of subarachnoid haemorrhage: a systematic review with emphasis on region, age, gender and time trends. J Neurol Neurosurg Psychiatry 78:1365–1372PubMedCentralCrossRefPubMed
3.
Ingall T, Asplund K, Mahonen M, Bonita R (2000) A multinational comparison of subarachnoid hemorrhage epidemiology in the WHO MONICA stroke study. Stroke 31:1054–1061CrossRefPubMed
4.
Lai L, Morgan MK (2012) Incidence of subarachnoid haemorrhage: an Australian national hospital morbidity database analysis. J Clin Neurosci 19:733–739CrossRefPubMed
5.
Sandvei MS, Mathiesen EB, Vatten LJ, Muller TB, Lindekleiv H, Ingebrigtsen T, Njolstad I, Wilsgaard T, Lochen ML, Vik A, Romundstad PR (2011) Incidence and mortality of aneurysmal subarachnoid hemorrhage in two Norwegian cohorts, 1984–2007. Neurology 77:1833–1839CrossRefPubMed
6.
Broderick JP, Brott T, Tomsick T, Miller R, Huster G (1993) Intracerebral hemorrhage more than twice as common as subarachnoid hemorrhage. J Neurosurg 78:188–191CrossRefPubMed
7.
Mohr JP, Caplan LR, Melski JW, Goldstein RJ, Duncan GW, Kistler JP, Pessin MS, Bleich HL (1978) The Harvard Cooperative Stroke Registry: a prospective registry. Neurology 28:754–762CrossRefPubMed
8.
Sacco S, Marini C, Toni D, Olivieri L, Carolei A (2009) Incidence and 10-year survival of intracerebral hemorrhage in a population-based registry. Stroke 40:394–399CrossRefPubMed
9.
Hillier SL, Hiller JE, Metzer J (1997) Epidemiology of traumatic brain injury in South Australia. Brain Inj 11:649–659CrossRefPubMed
10.
Rutland-Brown W, Langlois JA, Thomas KE, Xi YL (2006) Incidence of traumatic brain injury in the United States, 2003. J Head Trauma Rehabil 21:544–548CrossRefPubMed
11.
Tagliaferri F, Compagnone C, Korsic M, Servadei F, Kraus J (2006) A systematic review of brain injury epidemiology in Europe. Acta Neurochir (Wien) 148:255–268, discussion 268 CrossRef
12.
Beer R, Lackner P, Pfausler B, Schmutzhard E (2008) Nosocomial ventriculitis and meningitis in neurocritical care patients. J Neurol 255:1617–1624CrossRefPubMed
13.
Aucoin PJ, Kotilainen HR, Gantz NM, Davidson R, Kellogg P, Stone B (1986) Intracranial pressure monitors. Epidemiologic study of risk factors and infections. Am J Med 80:369–376CrossRefPubMed
14.
Bogdahn U, Lau W, Hassel W, Gunreben G, Mertens HG, Brawanski A (1992) Continuous-pressure controlled, external ventricular drainage for treatment of acute hydrocephalus—evaluation of risk factors. Neurosurgery 31:898–903, discussion 903–894 CrossRefPubMed
15.
Clark WC, Muhlbauer MS, Lowrey R, Hartman M, Ray MW, Watridge CB (1989) Complications of intracranial pressure monitoring in trauma patients. Neurosurgery 25:20–24CrossRefPubMed
16.
Khan SH, Kureshi IU, Mulgrew T, Ho SY, Onyiuke HC (1998) Comparison of percutaneous ventriculostomies and intraparenchymal monitor: a retrospective evaluation of 156 patients. Acta Neurochir Suppl 71:50–52PubMed
17.
Stenager E, Gerner-Smidt P, Kock-Jensen C (1986) Ventriculostomy-related infections--an epidemiological study. Acta Neurochir (Wien) 83:20–23CrossRef
18.
Lozier AP, Sciacca RR, Romagnoli MF, Connolly ES Jr (2002) Ventriculostomy-related infections: a critical review of the literature. Neurosurgery 51:170–181, discussion 181–172 CrossRefPubMed
19.
van de Beek D, Drake JM, Tunkel AR (2010) Nosocomial bacterial meningitis. N Engl J Med 362:146–154CrossRefPubMed
20.
Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM, Whitley RJ (2004) Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 39:1267–1284CrossRefPubMed
21.
Berger C, Schwarz S, Schaebitz WR, Aschoff A, Schwab S (2002) Serum procalcitonin in cerebral ventriculitis. Crit Care Med 30:1778–1781CrossRefPubMed
22.
Zarrouk V, Vassor I, Bert F, Bouccara D, Kalamarides M, Bendersky N, Redondo A, Sterkers O, Fantin B (2007) Evaluation of the management of postoperative aseptic meningitis. Clin Infect Dis 44:1555–1559CrossRefPubMed
23.
Horan TC, Andrus M, Dudeck MA (2008) CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 36:309–332CrossRefPubMed
24.
Neuman MI, Tolford S, Harper MB (2008) Test characteristics and interpretation of cerebrospinal fluid Gram stain in children. Pediatr Infect Dis J 27:309–313CrossRefPubMed
25.
Hunt WE, Hess RM (1968) Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28:14–20CrossRefPubMed
26.
Fisher CM, Kistler JP, Davis JM (1980) Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6:1–9CrossRefPubMed
27.
Hemphill JC 3rd, Bonovich DC, Besmertis L, Manley GT, Johnston SC (2001) The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke 32:891–897CrossRefPubMed
28.
van Mourik MS, Moons KG, van Solinge WW, Berkelbach-van der Sprenkel JW, Regli L, Troelstra A, Bonten MJ (2012) Automated detection of healthcare-associated infections: external validation and updating of a model for surveillance of drain-related meningitis. PLoS One 7:e51509PubMedCentralCrossRefPubMed
29.
Mayhall CG, Archer NH, Lamb VA, Spadora AC, Baggett JW, Ward JD, Narayan RK (1984) Ventriculostomy-related infections. A prospective epidemiologic study. N Engl J Med 310:553–559CrossRefPubMed
30.
Weisfelt M, van de Beek D, Spanjaard L, de Gans J (2007) Nosocomial bacterial meningitis in adults: a prospective series of 50 cases. J Hosp Infect 66:71–78CrossRefPubMed
31.
Pfisterer W, Muhlbauer M, Czech T, Reinprecht A (2003) Early diagnosis of external ventricular drainage infection: results of a prospective study. J Neurol Neurosurg Psychiatry 74:929–932PubMedCentralCrossRefPubMed
32.
Pfausler B, Beer R, Engelhardt K, Kemmler G, Mohsenipour I, Schmutzhard E (2004) Cell index—a new parameter for the early diagnosis of ventriculostomy (external ventricular drainage)-related ventriculitis in patients with intraventricular hemorrhage? Acta Neurochir (Wien) 146:477–481CrossRef
33.
Leib SL, Boscacci R, Gratzl O, Zimmerli W (1999) Predictive value of cerebrospinal fluid (CSF) lactate level versus CSF/blood glucose ratio for the diagnosis of bacterial meningitis following neurosurgery. Clin Infect Dis 29:69–74CrossRefPubMed
34.
Nathan BR, Scheld WM (2002) The potential roles of C-reactive protein and procalcitonin concentrations in the serum and cerebrospinal fluid in the diagnosis of bacterial meningitis. Curr Clin Top Infect Dis 22:155–165PubMed
35.
Schade RP, Schinkel J, Roelandse FW, Geskus RB, Visser LG, van Dijk JM, Voormolen JH, Van Pelt H, Kuijper EJ (2006) Lack of value of routine analysis of cerebrospinal fluid for prediction and diagnosis of external drainage-related bacterial meningitis. J Neurosurg 104:101–108CrossRefPubMed
36.
Gordon M, Ramirez P, Soriano A, Palomo M, Lopez-Ferraz C, Villarreal E, Meseguer S, Gomez M, Folgado C, Bonastre J (2014) Diagnosing external ventricular drain-related ventriculitis by means of local inflammatory response: soluble triggering receptor expressed on myeloid cells-1. Crit Care 18:567PubMedCentralCrossRefPubMed
37.
Lopez-Cortes LF, Marquez-Arbizu R, Jimenez-Jimenez LM, Jimenez-Mejias E, Caballero-Granado FJ, Rey-Romero C, Polaina M, Pachon J (2000) Cerebrospinal fluid tumor necrosis factor-alpha, interleukin-1beta, interleukin-6, and interleukin-8 as diagnostic markers of cerebrospinal fluid infection in neurosurgical patients. Crit Care Med 28:215–219CrossRefPubMed
Metadata
Title
Indicators of external ventricular drainage-related infections—a retrospective observational study
Publication date
01-03-2016
Published in
Acta Neurochirurgica / Issue 3/2016
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-016-2709-4

Other articles of this Issue 3/2016

Acta Neurochirurgica 3/2016 Go to the issue

Case Report - Brain Injury

A posttraumatic pontomedullary rent with good outcome

Technical Note - Neurosurgical Techniques

Purely endoscopic removal of a parasagittal/falx meningioma

Clinical Article - Spine

Orientation of the facet joints in degenerative rotatory lumbar scoliosis: an MR study on 52 patients

Clinical Article - Spine

Intraforaminal ozone therapy and particular side effects: preliminary results and early warning

Clinical Article - Neurosurgical Techniques

Cerebrospinal fluid disturbance in overweight women after occipitocervical decompression in Chiari malformation type I

Clinical Article - Neurosurgical Anatomy

Fronto-temporal branch of facial nerve within the interfascial fat pad: is the interfascial dissection really safe?