Ventriculostomy related infection in intensive care unit: Diagnostic criteria and related conditions

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• 作者：Sergio Castañ ; o Á ; vila ; ^{sergio.castanoavila@osakidetza.net" class="auth_mail" title="E-mail the corresponding author} ; Esther Corral Lozano ; Javier Maynar Moliner ; Fernando Fonseca San Miguel ; Elena Usó ; n Garcí ; a ; Yolanda Poveda Herná ; ndez ; Sara Cabañ ; es Daro-Francé ; s ; Goiatz Balziskueta Fló ; rez ; Noemi Legaristi Martí ; nez ; Amaia Quintano Rodero ; Ana Tejero Mojena ; Alberto Manzano Ramí ; rez
• 关键词：Intensive care unit ; Ventriculostomy ; Cerebral ventriculitis ; Diagnosis ; Risk factors ; Aseptic meningitis ; Intracranial pressure
• 刊名：Journal of Acute Disease
• 出版年：2016
• 出版时间：1 March 2016
• 年：2016
• 卷：5
• 期：2
• 页码：143-149
• 全文大小：320 K

文摘

To evaluate the usefulness of clinical signs, blood tests, microbiological cultures and cerebrospinal fluid (CSF) analysis to detect ventriculostomy related infections (VRI), and to describe related conditions.

Methods

A retrospective study was carried out including all patients with external ventricular drain admitted to intensive care unit from January 2000 to December 2006. Diagnosis of VRI, mortality, demographic and clinical data, time and number of drains, microbiological and biochemical CSF results and blood test were recorded. Difference between infected and uninfected patients was statistically significant at P < 0.05.

Results

The results revealed 136 drainages in 120 patients with 22 (18.33%) infected (15.39 infections per 1 000 days of drainage). This group was on overage older, had more severe systemic response syndrome and a significantly higher number of drains and longer duration of drain insertion. We found statistical differences in proteinorrachia, glycorrhachia, and glycorrachia/glycemia ratio during 8.5-day drain insertion (interquartile range 7–10.25). A total of 31 cultures were positive in patients without VRI and 47 were negative in patients with VRI. Furthermore, 35 patients died (2 belonging to the infected group). Significantly higher risk of VRI in intraventricular fibrinolysis and subarachnoid haemorrhage was observed. We made a multivariate regression model resulting in a prediction rule with 55.7% area under curve (95% CI 0.43–0.70).

Conclusions

CSF routine cultures and biochemical studies are not recommended to diagnose VRI. Clinical signs, external ventricular drain manipulation and a drainage insertion over a week justify the routine measurement of proteinorraquia, glycorrhachia and the ratio of glycorrachia/glycemia.