Ventriculostomy-related infections: The performance of different definitions for diagnosing infection

Abstract

Introduction Comparison of rates of ventriculostomy-related infections (VRI) across institutions is difficult due to the lack of a standard definition. We sought to review published definitions of VRI and apply them to a test cohort to determine the degree of variability in VRI diagnosis. Materials and Methods We conducted a PubMed search for definitions of VRI using the search strings “ventriculostomy-related infection” and “ventriculostomy-associated infection.” We applied these definitions to a test cohort of 18 positive cerebrospinal fluid (CSF) cultures taken from ventriculostomies at two institutions to compare the frequency of infection using each definition. Results We found 16 unique definitions of VRI. When the definitions were applied to the test cohort, the frequency of infection ranged from 22–94% (median 61% with interquartile range (IQR) 56–74%). The concordance between VRI diagnosis and treatment with VRI-directed antibiotics for at least seven days ranged from 56–89% (median 72%, IQR 71–78%). Conclusions The myriad of definitions in the literature produce widely different frequencies of infection. In order to compare rates of VRI between institutions for the purposes of qualitative metrics and research, a consistent definition of VRI is needed.

Comparison of Rates of Drain-Related Ventriculitis According to Definitions Used

“…However, only 7 of 16 definitions (44%) were objective, that is, they relied on laboratory data and clinical findings that were not overly open to interpretation. 6 This finding explains, in large part, the variation in infection rates described in the literature.…”

“…6 A positive CSF culture was required in 50% of these definitions, but no definitions mandated that more than 1 CSF culture be positive to confirm infection. However, only 7 of 16 definitions (44%) were objective, that is, they relied on laboratory data and clinical findings that were not overly open to interpretation.…”

Diagnostic Approach to Health Care- and Device-Associated Central Nervous System Infections

“…In the setting of insensitive and nonspecific clinical signs, symptoms, imaging and laboratory tests, the diagnosis of health care-and device-associated CNS infection is challenging, and a lack of standardized diagnostic criteria has contributed to the problem. In the case of VAI, at least 16 different diagnostic criteria have been reported in the literature; when these definitions are applied to a test cohort, the frequency of infection ranges from 22% to 94% (52). The 2017 Infectious Diseases Society of America (IDSA) clinical practice guidelines for health care-associated ventriculitis and meningitis proposed standard definitions for the contamination, colonization, and infection of ventricular drains (Table 2) (27).…”

Comparing External Ventricular Drains-Related Ventriculitis Surveillance Definitions

“…1,3 This wide variability in the VAI incidence may be in part due to the challenge of diagnosing VAI in the presence of an abnormal cerebrospinal fluid (CSF) profile from underlying central nervous system disease, recent surgery 1,4 and differences between VAI definitions. 5,1 …”