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
Neurocritical Care
Published in: Neurocritical Care 3/2017

Open Access 01-06-2017 | Original Article

Clinical and Laboratory Characteristics for the Diagnosis of Bacterial Ventriculitis After Aneurysmal Subarachnoid Hemorrhage

Authors: J. Hoogmoed, D. van de Beek, B. A. Coert, J. Horn, W. P. Vandertop, D. Verbaan

Published in: Neurocritical Care | Issue 3/2017

Login to get access

Abstract

Background

The diagnosis of nosocomial bacterial ventriculitis in patients with subarachnoid hemorrhage (SAH) can be challenging.

Methods

We performed a retrospective study on the diagnostic accuracy of clinical and laboratory characteristics for the diagnosis of bacterial ventriculitis in 209 consecutive patients with an aneurysmal SAH admitted in a tertiary referral center from 2008 to 2010. Diagnostic value of clinical characteristics and inflammatory indexes in CSF and blood were determined for three diagnostic categories: (1) no suspicion for bacterial ventriculitis; (2) clinical suspicion for bacterial ventriculitis, defined as initiation of empirical antibiotic treatment for ventriculitis, but negative CSF cultures; and (3) CSF culture-positive bacterial ventriculitis.

Results

Empirical antibiotics for suspected ventriculitis was initiated in 48 of 209 (23 %) patients. CSF cultures were positive in 11 (5 %) patients. Within the group of suspected ventriculitis, only longer duration of CSF drainage and lower CSF red blood cell counts predicted for culture positivity. None of the other clinical features or inflammatory indexes in CSF and blood were associated with culture-proven bacterial ventriculitis.

Conclusions

Nosocomial bacterial ventriculitis in patients with aneurysmal SAH is often suspected but confirmed by culture in a minority of cases. Improvement of diagnostics for nosocomial bacterial ventriculitis in patients with aneurysmal SAH is needed.
Literature
1.
Vergouwen MDI, Fang J, Casaubon LK, et al. Higher incidence of in-hospital complications in patients with clipped versus coiled ruptured intracranial aneurysms. Stroke. 2011;42:3093–8.CrossRefPubMed
2.
Dasenbrock HH, Rudy RF, Smith TR, et al. Hospital-acquired infections after aneurysmal subarachnoid hemorrhage: a nationwide analysis. World Neurosurg. 2016;88:459–74.CrossRefPubMed
3.
Frontera JA, Fernandez A, Schmidt JM. Impact of nosocomial infectious complications after subarachnoid hemorrhage. Neurosurgery. 2008;62:80–7.CrossRefPubMed
4.
Fernandez A, Schmidt JM, Claassen J, et al. Fever after subarachnoid hemorrhage: risk factors and impact on outcome. Neurology. 2007;68:1013–9.CrossRefPubMed
5.
Laban K, Rinkel GJE, Vergouwen MDI. Nosocomial infections after aneurysmal subarachnoid hemorrhage: time course and causative pathogens. Int J Stroke. 2015;10:763–6.CrossRefPubMed
6.
Naidech AM, Bendok BR, Bernstein RA, et al. Fever burden and functional recovery after subarachnoid hemorrhage. Neurosurgery. 2008;63:212–7 discussion 217–8.CrossRefPubMed
7.
8.
Wartenberg KE, Schmidt JM, Claassen J, et al. Impact of medical complications on outcome after subarachnoid hemorrhage*. Crit Care Med PAP. 2006;34:617–623.CrossRef
9.
Lozier AP, Sciacca RR, Romagnoli DES, et al. Ventriculostomy-related infections: a critical review of the literature. Neurosurgery. 2002;51:170–82.CrossRefPubMed
10.
Beer R, Lackner P, Pfausler B, et al. Nosocomial ventriculitis and meningitis in neurocritical care patients. J Neurol. 2008;255:1617–24.CrossRefPubMed
11.
12.
Beer R, Pfausler B, Schmutzhard E. Management of nosocomial external ventricular drain-related ventriculomeningitis. Neurocrit Care. 2009;10:363–7.CrossRefPubMed
13.
Pfausler B, Beer R, Engelhardt K, et al. Cell index—a new parameter for the early diagnosis of ventriculostomy (external ventricular drainage)-related ventriculitis in patients with intraventricular hemorrhage? Acta Neurochir. 2004;146:477–81.CrossRefPubMed
14.
Schade RP, Schinkel J, Roelandse F, et al. Lack of value of routine analysis of cerebrospinal fluid for prediction and diagnosis of external drainage-related bacterial meningitis. J Neurosurg. 2006;104:101–8.CrossRefPubMed
15.
Schade RP, Schinkel J, Visser J, et al. Bacterial meningitis caused by the use of ventricular or lumbar cerebrospinal fluid catheters. J Neurosurg. 2005;102:229–34.CrossRefPubMed
16.
Hoefnagel D, Dammers R, Ter Laak-Poort MP, et al. Risk factors for infections related to external ventricular drainage. Acta Neurochir. 2008;150:209–14 discussion 214.CrossRefPubMed
17.
Report of World Federation of Neurological Surgeons Committee on a Universal Subarachnoid Hemorrhage Grading Scale. J Neurosurg. 1988; 68:985–86.
18.
Fisher C, Kistler J, Davis J. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized to tomographic scanning. Neurosurgery. 1980;6:1–9.CrossRefPubMed
19.
Fried HI, Nathan BR, Rowe AS, et al. The insertion and management of external ventricular drains: an evidence-based consensus statement: a statement for healthcare professionals from the Neurocritical Care Society. Neurocrit Care. 2016;24:61–81.CrossRefPubMed
20.
De Smet AMGA, Kluytmans JAJW, Cooper BS, et al. Decontamination of the digestive tract and oropharynx in ICU patients. N Engl J Med. 2009;360:20–31.CrossRefPubMed
21.
Van de Beek D, De Gans J, Spanjaard L, et al. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med. 2004;351:1849–59.CrossRefPubMed
22.
Muttaiyah S, Ritchie S, Upton A, et al. Clinical parameters do not predict infection in patients with external ventricular drains: a retrospective observational study of daily cerebrospinal fluid analysis. J Med Microbiol. 2008;57:207–9.CrossRefPubMed
23.
Dorhout Mees SM, Luitse MJA, Van den Bergh WM, et al. Fever after aneurysmal subarachnoid hemorrhage: relation with extent of hydrocephalus and amount of extravasated blood. Stroke. 2008;39:2141–3.CrossRefPubMed
24.
Todd MM, Hindman B, Clarke B, et al. Perioperative fever and outcome in surgical patients with aneurysmal subarachnoid hemorrhage. Neurosurgery. 2009;64:897–908 discussion 908.CrossRefPubMed
25.
Weisfelt M, Van de Beek D, Spanjaard L, et al. Nosocomial bacterial meningitis in adults: a prospective series of 50 cases. J Hosp Infect. 2007;66:71–8.CrossRefPubMed
26.
Murthy SB, Moradiya Y, Shah J, et al. Incidence, predictors, and outcomes of ventriculostomy-associated infections in spontaneous intracerebral hemorrhage. Neurocrit Care. 2016;24:389–96.CrossRefPubMed
27.
Viallon A, Desseigne N, Marjollet O, et al. Meningitis in adult patients with a negative direct cerebrospinal fluid examination: value of cytochemical markers for differential diagnosis. Crit Care. 2011;15:R136.CrossRefPubMedPubMedCentral
28.
Brouwer MC, Tunkel AR, Van de Beek D. Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. Clin Microbiol Rev. 2010;23:467–92.CrossRefPubMedPubMedCentral
29.
Scheithauer S, Bürgel U, Bickenbach J, et al. External ventricular and lumbar drainage-associated meningoventriculitis: prospective analysis of time-dependent infection rates and risk factor analysis. Infection. 2010;38:205–9.CrossRefPubMed
30.
Citerio G, Signorini L, Bronco A, et al. External ventricular and lumbar drain device infections in ICU patients: a prospective multicenter Italian study. Crit Care Med. 2015;43:1630–7.CrossRefPubMed
31.
Forgacs P, Geyer CA, Freidberg SR. Characterization of chemical meningitis after neurological surgery. Clin Infect Dis. 2001;32:179–85.CrossRefPubMed
32.
Ross D, Rosegay H, Pons V. Differentiation of aseptic and bacterial meningitis in postoperative neurosurgical patients. J Neurosurg. 1988;69:669–74.CrossRefPubMed
33.
34.
Festic E, Siegel J, Stritt M, et al. The utility of serum procalcitonin in distinguishing systemic inflammatory response syndrome from infection after aneurysmal subarachnoid hemorrhage. Neurocrit Care. 2014;20:375–81.CrossRefPubMed
35.
Wong GK, Poon WS, Ip M. Use of ventricular cerebrospinal fluid lactate measurement to diagnose cerebrospinal fluid infection in patients with intraventricular haemorrhage. J Clin Neurosci. 2008;15:654–5.CrossRefPubMed
36.
Sakushima K, Hayashino Y, Kawaguchi T, et al. Diagnostic accuracy of cerebrospinal fluid lactate for differentiating bacterial meningitis from aseptic meningitis: a meta-analysis. J Infect. 2011;62:255–62.CrossRefPubMed
37.
Liu Z, Tu P, Chen N, et al. Raised proinflammatory cytokine production within cerebrospinal fluid precedes fever onset in patients with neurosurgery-associated bacterial meningitis. Crit Care Med. 2015;43:2416–28.CrossRefPubMed
38.
Gordon M, Ramirez P, Soriano A, et al. Diagnosing external ventricular drain-related ventriculitis by means of local inflammatory response: soluble triggering receptor expressed on myeloid cells-1. Crit Care. 2014;18:576.CrossRef
39.
Zarrouk V, Leflon-Guibout V, Robineaux S, et al. Broad-range 16S rRNA PCR with cerebrospinal fluid may be unreliable for management of postoperative aseptic meningitis. J Clin Microbiol. 2010;48:3331–3.CrossRefPubMedPubMedCentral
40.
Deutch S, Dahlberg D, Hedegaard J, et al. Diagnosis of ventricular drainage-related bacterial meningitis by broad-range real-time polymerase chain reaction. Neurosurgery. 2007;61:306–11 discussion 311–2.CrossRefPubMed
41.
López-Cortés LF, Marquez-Arbizu R, Jimenez-Jimenez LM, et al. Cerebrospinal fluid tumor necrosis factor-[alpha], interleukin-1[beta], interleukin-6, and interleukin-8 as diagnostic markers of cerebrospinal fluid infection in neurosurgical patients. Crit Care Med. 2000;28:215–9.CrossRefPubMed
42.
Rath PM, Schoch B, Adamzik M, et al. Value of multiplex PCR using cerebrospinal fluid for the diagnosis of ventriculostomy-related meningitis in neurosurgery patients. Infection. 2014;42:621–7.CrossRefPubMed
43.
Scheithauer S, Bürgel U, Ryang Y, et al. Prospective surveillance of drain associated meningitis/ventriculitis in a neurosurgery and neurological intensive care unit. J Neurol Neurosurg Psychiatry. 2009;80:1381–5.CrossRefPubMed
44.
De Jonge E, Schultz M, Spanjaard L, et al. Effects of selective decontamination of digestive tract on mortality and acquisition of resistant bacteria in intensive care: a randomised controlled trial. Lancet. 2003;362:1011–6.CrossRefPubMed
Metadata
Title
Clinical and Laboratory Characteristics for the Diagnosis of Bacterial Ventriculitis After Aneurysmal Subarachnoid Hemorrhage
Authors
J. Hoogmoed
D. van de Beek
B. A. Coert
J. Horn
W. P. Vandertop
D. Verbaan
Publication date
01-06-2017
Publisher
Springer US
Published in
Neurocritical Care / Issue 3/2017
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-016-0345-8

Other articles of this Issue 3/2017

Neurocritical Care 3/2017 Go to the issue

Original Article

Clinical Value of Neutrophil to Lymphocyte and Platelet to Lymphocyte Ratio After Aneurysmal Subarachnoid Hemorrhage

Original Article

Validation of the Glycemic Stress Index in Pediatric Neurosurgical Intensive Care

Editorial

Bedside Ultrasound After Decompressive Craniectomy: A New Standard?

Original Article

Biomarkers of Glycocalyx Injury are Associated with Delayed Cerebral Ischemia Following Aneurysmal Subarachnoid Hemorrhage: A Case Series Supporting a New Hypothesis

Ethical Matters

Physician Power to Declare Death by Neurologic Criteria Threatened

Review Article

Zika Virus Disease for the Neurointensivist