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
BMC Pediatrics
Published in: BMC Pediatrics 1/2019

Open Access 01-12-2019 | CSF Drainage | Research article

Neutrophil CD64 index in cerebrospinal fluid as a marker of bacterial ventriculitis in children with external ventricular drainage

Authors: Mojca Groselj-Grenc, Metka Derganc, Andreja Natasa Kopitar, Maja Pavcnik

Published in: BMC Pediatrics | Issue 1/2019

Login to get access

Abstract

Background

Bacterial ventriculitis is a common complication in children with temporary external ventricular drains (EVD) and the diagnosis is challenging. The present study compared the diagnostic accuracy of novel cerebrospinal fluid (CSF) marker - CD64 expression on neutrophils measured as neutrophil CD64 index (CD64in) to routine laboratory CSF and blood markers for bacterial ventriculitis in children with EVD.

Methods

We conducted a prospective, observational study, enrolling children with EVD. CD64in in CSF together with CSF markers (leukocyte count, percentage of neutrophils, glucose, and proteins) and blood markers (leukocyte and differential count, C-reactive protein (CRP), and procalcitonin (PCT)) were studied at the time of suspected bacterial ventriculitis. CD64in was measured by flow cytometry. Diagnostic accuracy determined by the area under the receiver–operating characteristic (ROC) curves (AUC) was defined for each marker.

Results

Thirty-three episodes of clinically suspected ventriculitis in twenty-one children were observed during a 26-month period. Episodes were classified into those with microbiologically proven ventriculitis (13 episodes) and into those with microbiologically negative CSF (20 episodes). CD64in and leukocyte count were the only CSF markers that could differentiate between groups with diagnostic accuracy of 0.875 and 0.694, respectively. Among blood markers only CRP and band neutrophils differentiated between groups with diagnostic accuracy of 0.792 and 0.721, respectively.

Conclusions

CD64in in CSF is a promising diagnostic marker of bacterial ventriculitis in children with EVD as it has higher diagnostic accuracy than routine blood and CSF markers for diagnosing bacterial ventriculitis at the time of clinical suspicion.
Literature
1.
Tunkel AR, Hasbun R, Bhimraj A, et al. Infectious Diseases Society of America's clinical practice guidelines for healthcare-associated Ventriculitis and meningitis. Clin Infect Dis. 2017; Epub 2017 Feb 14.
2.
Pfausler B, Spiss H, Beer R, et al. Treatment of staphylococcal ventriculitis associated with external cerebrospinal fluid drains: a prospective randomized trial of intravenous compared with intraventricular vancomycin therapy. J Neurosurg. 2003;98(5):1040–4.CrossRef
3.
Phan K, Schultz K, Huang C, et al. External ventricular drain infections at the Canberra hospital: a retrospective study. J Clin Neurosci. 2016;32:95–8.CrossRef
4.
Ramanan M, Lipman J, Shorr A, Shankar A. A meta-analysis of ventriculostomy-associated cerebrospinal fluid infections. BMC Infect Dis. 2015;15:3.CrossRef
5.
Attenello FJ, Garces-Ambrossi GL, Zaidi HA, Sciubba DM, Jallo GI. Hospital costs associated with shunt infections in patients receiving antibiotic-impregnated shunt catheters versus standard shunt catheters. Neurosurgery. 2010;66(2):284–9.CrossRef
6.
Arnell K, Cesarini K, Lagerqvist-Widh A, Wester T, Sjölin J. Cerebrospinal fluid shunt infections in children over a 13-year period: anaerobic cultures and comparison of clinical signs of infection with Propionibacterium acnes and with other bacteria. J Neurosurg Pediatr. 2008;1(5):366–72.CrossRef
7.
Wang KW, Chang WN, Shih TY, et al. Infection of cerebrospinal fluid shunts: causative pathogens, clinical features, and outcomes. Jpn J Infect Dis. 2004;57(2):44–8.PubMed
8.
Sciubba DM, Lin LM, Woodworth GF, McGirt MJ, Carson B, Jallo GI. Factors contributing to the medical costs of cerebrospinal fluid shunt infection treatment in pediatric patients with standard shunt components compared with those in patients with antibiotic impregnated components. Neurosurg Focus. 2007;22(4):E9.CrossRef
9.
Rowensztein H, Manfrin L, Paglia M, Cong TL, Ruvinsky S, Scrigni A. Characteristics of cerebrospinal fluid (CSF) among children with ventriculoperitoneal shunt infections. Arch Argent Pediatr. 2015;113(3):244–6.PubMed
10.
Camacho EF, Boszczowski I, Basso M, et al. Infection rate and risk factors associated with infections related to external ventricular drain. Infection. 2011;39(1):47–51.CrossRef
11.
Leverstein-van Hall MA, Hopmans TE, van der Sprenkel JW, et al. A bundle approach to reduce the incidence of external ventricular and lumbar drain-related infections. J Neurosurg. 2010;112(2):345–53.CrossRef
12.
Miller C, Guillaume D. Incidence of hemorrhage in the pediatric population with placement and removal of external ventricular drains. J Neurosurg Pediatr. 2015;16(6):662–7.CrossRef
13.
14.
Lenfestey RW, Smith PB, Moody MA, et al. Predictive value of cerebrospinal fluid parameters in neonates with intraventricular drainage devices. J Neurosurg. 2007;107(3 Suppl):209–12.PubMed
15.
Schade RP, Schinkel J, Roelandse FW, 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(1):101–8.CrossRef
16.
Boer K, Vogelsang H, Deufel T, Pfister W, Kiehntopf M. CD62L on neutrophil granulocytes, a useful, complementary marker for the prediction of ventriculitis in blood-containing CSF. Clin Biochem. 2010;43(16–17):1351–5.CrossRef
17.
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(5):567.CrossRef
18.
Stubljar D, Kopitar AN, Groselj-Grenc M, Suhadolc K, Fabjan T, Skvarc M. Diagnostic accuracy of presepsin (sCD14-ST) for prediction of bacterial infection in cerebrospinal fluid samples from children with suspected bacterial meningitis or ventriculitis. J Clin Microbiol. 2015;53(4):1239–44.CrossRef
19.
Schoch B, Regel JP, Nierhaus A, et al. Predictive value of intrathecal interleukin-6 for ventriculostomy-related infection. Zentralbl Neurochir. 2008;69(2):80–6.CrossRef
20.
Lenski M, Huge V, Briegel J, Tonn JC, Schichor C, Thon N. Interleukin 6 in the cerebrospinal fluid as a biomarker for onset of vasospasm and ventriculitis after severe subarachnoid hemorrhage. World Neurosurg. 2017;99:132–9.CrossRef
21.
López-Cortés LF, Marquez-Arbizu R, Jimenez-Jimenez LM, et al. 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. 2000;28(1):215–9.CrossRef
22.
Berger C, Schwarz S, Schaebitz WR, Aschoff A, Schwab S. Serum procalcitonin in cerebral ventriculitis. Crit Care Med. 2002;30(8):1778–81.CrossRef
23.
Omar AS, ElShawarby A, Singh R. Early monitoring of ventriculostomy-related infections with procalcitonin in patients with ventricular drains. J Clin Monit Comput. 2015;29(6):759–65.CrossRef
24.
Nuutila J. The novel applications of the quantitative analysis of neutrophil cell surface FcgammaRI (CD64) to the diagnosis of infectious and inflammatory diseases. Curr Opin Infect Dis. 2010;23(3):268–74.CrossRef
25.
Groselj-Grenc M, Ihan A, Pavcnik-Arnol M, Kopitar AN, Gmeiner-Stopar T, Derganc M. Neutrophil and monocyte CD64 indexes, lipopolysaccharide-binding protein, procalcitonin and C-reactive protein in sepsis of critically ill neonates and children. Intensive Care Med. 2009;35(11):1950–8.CrossRef
26.
Groselj-Grenc M, Ihan A, Derganc M. Neutrophil and monocyte CD64 and CD163 expression in critically ill neonates and children with sepsis: comparison of fluorescence intensities and calculated indexes. Mediat Inflamm. 2008;202646.
27.
Liu Y, Hou JH, Li Q, Chen KJ, Wang SN, Wang JM. Biomarkers for diagnosis of sepsis in patients with systemic inflammatory response syndrome: a systematic review and meta-analysis. Springerplus. 2016;5(1):2091.CrossRef
28.
Streimish I, Bizzarro M, Northrup V, et al. Neutrophil CD64 as a diagnostic marker in neonatal sepsis. Pediatr Infect Dis J. 2012;31(7):777–81.CrossRef
29.
Mohamed HB, Alif HA, Awadalla AA, Azza ZL. Detection and significance of blood neutrophil CD64 expression as a diagnostic marker in bacterial meningitis in children. Egypt J Immunol. 2012;19(2):35–40.PubMed
30.
Schuhmann MU, Ostrowski KR, Draper EJ, et al. The value of C-reactive protein in the management of shunt infections. J Neurosurg. 2005;103(3 Suppl):223–30.PubMed
31.
Wiegand J, Hickson L, Merz TM. Indicators of external ventricular drainage-related infections–a retrospective observational study. Acta Neurochir. 2016;158(3):595–601.CrossRef
32.
Marchant EA, Boyce GK, Sadarangani M, Lavoie PM. Neonatal sepsis due to coagulase-negative staphylococci. Clin Dev Immunol. 2013;586076.
33.
Scheithauer S, Bürgel U, Ryang YM, 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.CrossRef
34.
Hoogmoed J, van de Beek D, Coert BA, Horn J, Vandertop WP, Verbaan D. Clinical and laboratory characteristics for the diagnosis of bacterial ventriculitis after aneurysmal subarachnoid hemorrhage. Neurocrit Care. 2017;26(3):362–70.CrossRef
35.
Beer R, Lackner P, Pfausler B, Schmutzhard E. Nosocomial ventriculitis and meningitis in neurocritical care patients. J Neurol. 2008;255(11):1617–24.CrossRef
36.
He T, Kaplan S, Kamboj M, Tang YW. Laboratory diagnosis of central nervous system infection. Curr Infect Dis Rep. 2016;18(11):35.CrossRef
37.
Rath PM, Schoch B, Adamzik M, Steinmann E, Buer J, Steinmann J. Value of multiplex PCR using cerebrospinal fluid for the diagnosis of ventriculostomy-related meningitis in neurosurgery patients. Infection. 2014;42(4):621–7.CrossRef
38.
Gordon CL, Tokarz R, Briese T, et al. Evaluation of a multiplex polymerase chain reaction for early diagnosis of ventriculostomy-related infections. J Neurosurg. 2015;123(6):1586–92.CrossRef
Metadata
Title
Neutrophil CD64 index in cerebrospinal fluid as a marker of bacterial ventriculitis in children with external ventricular drainage
Authors
Mojca Groselj-Grenc
Metka Derganc
Andreja Natasa Kopitar
Maja Pavcnik
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
CSF Drainage
Published in
BMC Pediatrics / Issue 1/2019
Electronic ISSN: 1471-2431
DOI
https://doi.org/10.1186/s12887-019-1497-4

Other articles of this Issue 1/2019

BMC Pediatrics 1/2019 Go to the issue

Research article

Prevalence, risk factors and seasonal variations of different Enteropathogens in Lebanese hospitalized children with acute gastroenteritis

Research article

Prevalence, risk factors and outcome of congenital anomalies among neonatal admissions in OGBOMOSO, Nigeria

Research article

A cross-sectional survey of adrenal steroid hormones among overweight/obese boys according to puberty stage

Research article

Effects of air pollution on children from a socioecological perspective

Case report

Thrombophlebitis hiding under a KILT – case report on 40 years long-term follow-up of neonatal renal vein thrombosis

Research article

Determinants of delayed diagnosis among pediatric cancer patients from Ayder Comprehensive Specialized Hospital, Mekelle, Northern Ethiopia