Characteristics of infections associated with external ventricular drains of cerebrospinal fluid

Sonication of catheter tips for improved detection of microorganisms on external ventricular drains and ventriculo-peritoneal shunts

“…In some cases, therefore, it can only provide retrospective evidence for, or confirmation of, meningitis. However, an earlier study at our institution found that 21% of infections occurred after removal of the EVD [27]. Indeed, two patients in our series with bacterial growth on the sonicated ventricular catheter tip, but sterile CSF cultures, later developed meningitis.…”

Raised Proinflammatory Cytokine Production Within Cerebrospinal Fluid Precedes Fever Onset in Patients With Neurosurgery-Associated Bacterial Meningitis*

“…On the other hand, the mortality rate for bacterial meningitis regularly approaches 100%, carrying a significant risk of severe neurological sequelae (32,36). Until recently, fever and raised CSF polymorphonuclear WBCs provided the mainstay of investigations for differentiating between bacterial and aseptic meningitis in the acute setting (37). However, CSF WBCs are often unreliable, particularly as polymorphonuclear pleocytosis predominates in the early phase of both viral and bacterial meningeal infections (8).…”

Surveillance and management of ventriculitis following neurosurgery

“…8 In a retrospective Swiss study of 48 patients with EVD-associated meningitis/ventriculitis comparing findings at the time of insertion with those on presentation with infection, fever and meningism were more frequent at the time of diagnosis but the Glasgow coma scale was lower at the time of EVD insertion. 9 An increased CSF leucocyte count was predictive of infection but a raised serum C-reactive protein was the most predictive. Scheitauer et al prospectively surveyed 1333 patients using the US Centers for Disease Control and Prevention definitions, which categorize meningitis/ventriculitis into definite and probable.…”