Decreasing External Ventricular Drain Infection Rates in the Neurocritical Care Unit: 12-Year Longitudinal Experience at a Single Institution

Walek, Konrad; Leary, Owen P.; Sastry, Rahul; Asaad, Wael F.; Walsh, Joan M.; Mermel, Leonard A.

doi:10.1016/j.wneu.2021.02.087

Cited by 17 publications

(22 citation statements)

References 35 publications

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“…102 An overview of prevention studies of the last decade is displayed in Table 2. 28,85,101,[103][104][105][106][107][108][109][110][111][112][113][114][115][116][117][118][119]…”

Section: Dovepressmentioning

confidence: 99%

Current Perspectives on the Diagnosis and Management of Healthcare-Associated Ventriculitis and Meningitis

Karvouniaris¹,

Brotis²,

Tsiakos³

et al. 2022

IDR

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Ventriculitis or post-neurosurgical meningitis or healthcare-associated ventriculitis and meningitis (VM) is a severe infection that complicates central nervous system operations or is related to the use of neurosurgical devices or drainage catheters. It can further deteriorate patients who have already presented significant neurologic injury and is associated with high morbidity, mortality, and poor functional outcome. VM can be difficult to distinguish from aseptic meningitis, inflammation that follows hemorrhagic strokes and neurosurgical operations. The associated microorganisms can be either skin flora or nosocomial pathogens, most commonly, Gram-negative bacteria. Classical microbiology can fail to isolate the culprit pathogen. Novel cerebrospinal fluid (CSF) biomarkers and molecular microbiology can fill the diagnostic gap and expedite pathogen identification and treatment. The pathogens may demonstrate significant resistant patterns and their antibiotic treatment can be difficult, as many important drug classes, including the beta-lactams and the glycopeptides, hardly penetrate to the CSF, and do not achieve therapeutic levels at the site of the infection. Treatment modifications, such as higher daily dose and prolonged or continuous administration, might increase antibiotic levels in the site of infection and facilitate pathogens clearance. However, in the case of therapeutic failure or infection due to difficultto-treat bacteria, the direct antibiotic instillation into the CSF, in addition to the intravenous antibiotic delivery, may help in the resolution of infection. However, intraventricular antibiotic therapy may result in aseptic meningitis and seizures, concerning the administration of aminoglycosides, polymyxins, and vancomycin. Meanwhile, bacteria form biofilms on the catheter or the device that should routinely be removed. Novel neurosurgical treatment modalities comprise endoscopic evacuation of debris and irrigation of the ventricles. VM prevention includes perioperative antibiotics, antimicrobial impregnated catheters, and the implementation of standardized protocols, regarding catheter insertion and manipulation.

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“…102 An overview of prevention studies of the last decade is displayed in Table 2. 28,85,101,[103][104][105][106][107][108][109][110][111][112][113][114][115][116][117][118][119]…”

Section: Dovepressmentioning

confidence: 99%

Current Perspectives on the Diagnosis and Management of Healthcare-Associated Ventriculitis and Meningitis

Karvouniaris¹,

Brotis²,

Tsiakos³

et al. 2022

IDR

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“…for the entire stay of external ventricular drains) is not recommended. It is recommended to limit manipulation and avoid fixed interval exchanges of drains or routine sampling of CSF [33]. Education of healthcare professionals on preventive measures could significantly reduce the HCAMV rate [34].…”

Section: Recent Findingsmentioning

confidence: 99%

Healthcare-associated central nervous system infections

Ippolito

Giarratano

Cortegiani

2022

Current Opinion in Anaesthesiology

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Purpose of reviewThe aim of this review is to provide a practical and updated summary on healthcare-associated central nervous system infections and their management. Recent findingsThe term 'healthcare-associated ventriculitis and meningitis' has recently been coined and clinical practical guidelines have been published on the management of these nosocomial infections. Many aspects have still to be further investigated (e.g. cerebrospinal fluid biomarkers, indications for novel antibiotics, intrathecal antimicrobial regimens). SummaryClinicians should maintain a high index of suspicion for healthcare-associated central nervous system infections in patients with specific risk factors (i.e. recent neurosurgery, cerebrospinal shunts, drains or implantable devices, head/spinal traumatic events), taking into account systemic signs, and alterations in microbiological, imaging, cerebrospinal fluid findings. The diagnosis is often difficult to confirm because of reduced levels of consciousness or coma. Both Gram-positive and Gram-negative (often multidrug-resistant or even pandrug-resistant) microorganisms may be the cause. Selection of antibiotics must consider susceptibility and penetration into the central nervous system. Ineffective treatments are frequent, and mortality can reach 60%. Future research should focus on the diagnostic performance of biomarkers and on the use of novel antimicrobial regimens, especially for the treatment of difficult to treat infections.

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“…Numerous bundles that target the prevention of ventriculitis in patients with EVD have been defined [70][71][72][73]. They typically feature protocolization of various aspects of care, including choice of EVD (e.g., antibiotic-impregnated), prophylactic and periprocedural antibiotics, skin preparation, aseptic and operative techniques, EVD tunneling distance, maintenance cares (e.g., sampling frequency, monitoring, disconnections), and infection surveillance.…”

Section: Prevention Bundlesmentioning

confidence: 99%

“…They typically feature protocolization of various aspects of care, including choice of EVD (e.g., antibiotic-impregnated), prophylactic and periprocedural antibiotics, skin preparation, aseptic and operative techniques, EVD tunneling distance, maintenance cares (e.g., sampling frequency, monitoring, disconnections), and infection surveillance. Benefits ranging from reduced rates of ventriculitis to shorter duration and fewer doses of antibiotics without an increase in ventriculitis and reduced rates of multiresistant organism infections have been reported from the use of bundles [70][71][72][73]. With the absence of harm and possibility of benefit, institutions that manage patients with EVDs should strongly consider the adoption of a protocolized bundle aimed at preventing ventriculitis.…”

Section: Prevention Bundlesmentioning

confidence: 99%

Ventriculitis: Infection or Inflammation

2021

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Ventriculitis, or infection of the cerebrospinal fluid, in the presence of external ventricular drains (EVD), is an important complication and associated with substantial mortality, morbidity, and healthcare costs. Further, the conditions that require the insertion of an EVD, such as neurotrauma and subarachnoid hemorrhage, are themselves associated with inflammation of the cerebrospinal fluid. Phenotypically, patients with inflammation of the cerebrospinal fluid can present with very similar symptoms, signs, and laboratory findings to those with infection. This review examines various controversies relating to the definitions, diagnosis, challenges of differentiating infection from inflammation, prevention, and treatment of ventriculitis in patients with EVDs.

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Decreasing External Ventricular Drain Infection Rates in the Neurocritical Care Unit: 12-Year Longitudinal Experience at a Single Institution

Cited by 17 publications

References 35 publications

Current Perspectives on the Diagnosis and Management of Healthcare-Associated Ventriculitis and Meningitis

Current Perspectives on the Diagnosis and Management of Healthcare-Associated Ventriculitis and Meningitis

Healthcare-associated central nervous system infections

Ventriculitis: Infection or Inflammation

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