Factors Contributing to Ventriculostomy Infection

Kim, Joon‐Hyung; Desai, Naman S.; Ricci, Joseph A.; Stieg, Philip E.; Rosengart, Axel J.; Härtl, Roger; Fraser, Justin F.

doi:10.1016/j.wneu.2011.04.017

Cited by 79 publications

(44 citation statements)

References 26 publications

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“…The overall rates of ventriculitis of 11.7% (7 of 60 patients) in the randomized study and 8.1% (3 of 37 patients) in the observational study at our institution are similar to reported averages. 10 This finding further supports the belief that the difference in infection rates is related to group differences and not institutional differences.…”

Section: 9supporting

confidence: 62%

“…Kim et al summarized the results from 17 studies and reported an average infection rate of 9.5% (range 0%-22%). 10 In the observational study of continuous and intermittent CSF drainage, 12.5% of patients who underwent continuous CSF drainage versus 0% of those who underwent intermittent drainage were diagnosed with ventriculitis. 9 To fully explore the relative risk of infection for patients undergoing continuous CSF drainage, we combined the sample populations from the randomized and observational studies conducted at our institution.…”

Section: 9mentioning

confidence: 99%

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Continuous cerebral spinal fluid drainage associated with complications in patients admitted with subarachnoid hemorrhage

Olson

Zomorodi

Britz

et al. 2013

JNS

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Object Cerebral artery vasospasm is a major cause of death and disability in patients recovering from subarachnoid hemorrhage (SAH). Although the exact cause of vasospasm is unknown, one body of research suggests that clearing blood products by CSF drainage is associated with a lower frequency and severity of vasospasm. There are multiple approaches to facilitating CSF drainage, but there is inadequate evidence to determine the best practice. The purpose of this study was to explore whether continuous or intermittent CSF drainage was superior for reducing vasospasm. Methods The authors performed a randomized clinical trial. Within 72 hours of admission for SAH, patients with an external ventricular drain (EVD) were randomized to undergo continuous CSF drainage with intermittent intracranial pressure (ICP) monitoring (open-EVD group) or continuous ICP monitoring with intermittent CSF drainage (monitor-ICP group). Results After 60 patients completed the study, an interim analysis was performed. The complication rate of 52.9% for the open-EVD group was significantly higher than the 23.1% complication rate for the monitor-ICP group (OR 3.75, 95% CI 1.21–11.66, p = 0.022). These results were reported to the Data Safety and Monitoring Board and enrollment was terminated. The odds ratio of vasospasm for the open-EVD versus monitor-ICP group was not significant (OR 0.44, 95% CI 0.13–1.45, p = 0.177). Conclusions Continuous CSF drainage with intermittent ICP monitoring is associated with a higher rate of complications than continuous ICP monitoring with intermittent CSF drainage, but there is no difference between the two types of monitoring in vasospasm. Clinical trial registration no.: NCT01169454 (clinicaltrials.gov).

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Section: 9supporting

confidence: 62%

Section: 9mentioning

confidence: 99%

Continuous cerebral spinal fluid drainage associated with complications in patients admitted with subarachnoid hemorrhage

Olson

Zomorodi

Britz

et al. 2013

JNS

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“…In the present study, we measured PI and MLS as surrogate parameters for increased ICP at different time points, covering the initial and subacute phase of edema formation. In comparison to invasive ICP monitoring, which may lead to complications such as hemorrhage and infection [38,39,40], PI monitoring is noninvasive, and thus, does not cause complications. Moreover, costs of ventriculostomy and the installation of microtransducers by far exceed those of TCD.…”

Section: Discussionmentioning

confidence: 99%

Doppler Pulsatility Index in Spontaneous Intracerebral Hemorrhage

Kiphuth¹,

Huttner²,

Dörfler

et al. 2013

Eur Neurol

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Background and Purpose: Elevated intracranial pressure (ICP) as a result of intracerebral hemorrhage (ICH) and perihematomal edema often leads to tissue shift, which can be identified in cross-sectional imaging and presents a known predictor of functional outcome. Pulsatility indices (PIs) of the intracranial arteries as measured by transcranial Doppler sonography (TCD) may serve as surrogate parameters for ICP. This study aims to investigate whether PI correlates with ICP and midline shift and serves as a reliable predictor of functional outcome in patients with ICH. Methods: Within a 1-year period between April 2009 and April 2010, 136 patients with acute spontaneous, supratentorial ICH were admitted to our tertiary care hospital. One-hundred and twenty-four patients fulfilled the inclusion criteria and were eligible for analysis. TCD and transcranial duplex sonography were performed on admission and at least once more during hospital stay. Functional outcome was assessed 6 months after discharge. Correlation analyses, logistic regression analyses and receiver operating characteristic curves were calculated. Results: One-hundredand twenty-four patients were included in the analysis. Six-month mortality amounted to 39.5%. The ICH score and PIs of the middle cerebral artery were independent predictors of outcome 6 months after discharge. Conclusions: Early PI monitoring by TCD correlated with ICP and may be used to predict the outcome after 6 months.

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“…1,7 An increased risk of infection has been observed in patients with i) subarachnoid or IVH or with concurrent systemic infections, ii) longer duration of catheterization, iii) cerebrospinal fl uid (CSF) leakage, iv) frequent manipulation of the EVD system. 1,6,8 The objectives of the present study is to assess the incidence of EVD infection rate in the study center, identify the most common bacteria retrieved from cultures and the antibiotic sensitivity patterns and estimate the total drainage time related to the risk of a positive bacteriological CSF culture. In addition relevant literature was reviewed elaborately.…”

mentioning

confidence: 99%

External Ventricular Drainage Infections: Experience From a Tertiary Care Center in Nepal

Pradhanang¹,

Sharma²,

Sedain³

et al. 2016

Nep J Neurosci

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External Ventricular Drainage (EVD) related infection is one of the most dreaded infections in neurosurgical practice. The primary aim of this study was to assess the incidence of EVD infections in our hospital. In addition, we have made an attempt to evaluate the indication for EVD placement, influence of total drainage time in the risk of catheter infection, the most common bacterial spectra in cerebrospinal fluid (CSF) culture, and their antibiotic sensitivity pattern. This is a retrospective study of all patients who underwent EVD placement over a period of two years.Out of 60 patients who underwent EVD placement, 52 met the inclusion criteria for analysis. The ventricular catheters were in place from 1 to 23 days. Overall shunt infection rate was 36.5%. CSF cell count significantly correlated with the occurrence of a positive CSF culture (unpaired t test, p<0.05). The most common bacterial species isolated were Acinetobacter baumannii and Burkholderia cepacia.Despite many advances in care, there is still a significantly high incidence of EVD related infections. Contrary to earlier reports, the most common bacterial grown in our center were quite different and their antibiotic sensitivity varied accordingly.Nepal Journal of Neuroscience 12:67-71, 2015

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Factors Contributing to Ventriculostomy Infection

Cited by 79 publications

References 26 publications

Continuous cerebral spinal fluid drainage associated with complications in patients admitted with subarachnoid hemorrhage

Continuous cerebral spinal fluid drainage associated with complications in patients admitted with subarachnoid hemorrhage

Doppler Pulsatility Index in Spontaneous Intracerebral Hemorrhage

External Ventricular Drainage Infections: Experience From a Tertiary Care Center in Nepal

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