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Neurocritical Care

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01-06-2009 | PRACTICAL PEARL

Management of Nosocomial External Ventricular Drain-Related Ventriculomeningitis

Authors: Ronny Beer, Bettina Pfausler, Erich Schmutzhard

Published in: Neurocritical Care | Issue 3/2009

Abstract

Introduction

Neurocritical care patients requiring external ventricular drainage are at risk for the development of a device-related infection. Infection rate of external ventriculostomy catheters is high with reported incidences ranging from 5% up to more than 20%. Nosocomial ventriculitis or ventriculomeningitis are potential life-threatening conditions which may contribute to a permanent adverse outcome of the patient. Reducing morbidity and mortality is strongly dependent on prompt diagnosis and on the initiation of appropriate antiinfective therapy.

Scientific Background

Management of nosocomial ventriculitis is challenging and needs to consider the most likely pathogens involved, local resistance patterns, the nature of the underlying disease, patient factors such as age, comorbidity, and immune status. Further, decisions on catheter exchange and the type and duration of systemic or local antimicrobial therapy have to be made. Because so many factors have to be taken into account, it is evident that the diagnostic and therapeutic approach to nosocomial ventriculitis is difficult to standardize. Staphylococci are the pathogens most frequently identified in nosocomial ventriculitis. Therefore, initial treatment with an antistaphylococcal agent with adequate cerebrospinal fluid penetration may be considered as first-line therapy for this infection.

Conclusion

In the review of a contemporary case we will discuss important issues in the management of device-related ventriculitis.

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Title: Management of Nosocomial External Ventricular Drain-Related Ventriculomeningitis
Authors: Ronny Beer
Bettina Pfausler
Erich Schmutzhard
Publication date: 01-06-2009
Publisher: Humana Press Inc
Published in: Neurocritical Care / Issue 3/2009
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI: https://doi.org/10.1007/s12028-008-9155-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Management of Nosocomial External Ventricular Drain-Related Ventriculomeningitis

Abstract

Introduction

Scientific Background

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Scientific Background

Conclusion

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