Ventriculostomy infections: the effect of monitoring duration and catheter exchange in 584 patients

Abstract

The investigators undertook a retrospective analysis of ventriculostomy infections to evaluate their relationship to monitoring duration and prophylactic catheter exchange. In 1984, the results of an epidemiological study of ventriculostomy-related infection were published. One of the conclusions of the paper was that the incidence of ventriculostomy-related infections rose after 5 days of monitoring. This led to the recommendation that catheters be prophylactically changed at 5-day intervals if prolonged monitoring was required. A recent randomized prospective study on central venous catheters showed no reduction in infection with prophylactic catheter exchanges. This has led the authors to reexamine their experience with ventriculostomy infections. Data on 584 severely head injured patients with ventriculostomies were prospectively collected in two data banks, The Traumatic Coma Data Bank and The Medical College of Virginia Neurocore Data Bank. These data were retrospectively analyzed for factors associated with ventriculostomy related infections. It was found that there is a relationship of ventriculitis to monitoring duration but it is not simple or linear. There is a rising risk of infection over the first 10 days, but infection then becomes very unlikely despite a population that continues to be at risk. Patients in whom catheters were replaced prior to 5 days did not have a lower infection rate than those whose catheters were exchanged at more than 5-day intervals. Based on these data, it is recommended that ventriculostomy catheters for intracranial pressure monitoring be removed as quickly as possible, and in circumstances in which prolonged monitoring is required, there appears to be no benefit from catheter exchange.

Lack of value of routine analysis of cerebrospinal fluid for prediction and diagnosis of external drainage–related bacterial meningitis

“…Furthermore, 54% of the patients with external drains suffered from ED-BM, a percentage that is three to seven times higher than that reported in the literature. 4,8,13,14,20,21,25 It is therefore difficult to apply their results to general practice. We used the cell index parameter, as defined by Pfaulser, et al, to analyze the data from our cohort, but we failed to demonstrate a predictive or diagnostic value for ED-BM (data not shown).…”

Continuous ventricular cerebrospinal fluid drainage with intracranial pressure monitoring for management of posttraumatic diffuse brain swelling

“…It is has been demonstrated that the risk of infection increases after five days of ventriculostomy catheter placement, with an overall risk estimated 8.6%-11% [28][29][30][31][32] . Conversely, a study has reported that the length of ICP monitoring does not influence the infection rate and, therefore, the decision to keep the catheter should be based solely on the need for ICP control 33 .…”

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“…Existe farta literatura sobre as complicações infecciosas 1,3,4,[9][10][11]15,18 , mas o assunto foge aos objetivos deste trabalho. Entretanto, a literatura sobre os problemas mecânicos de bolsas de drenagem é relativamente escassa, talvez porquê o mais grave deles, que é a hiperdrenagem liquórica, ocorra devido ao manuseio incorreto do sistema de derivação externa, e talvez esse fato não seja comum em países desenvolvidos, mas ocorre com freqüência em países de terceiro mundo.…”