1
|
Atallah O, Krauss JK, Hermann EJ. External ventricular drainage in pediatric patients: indications, management, and shunt conversion rates. Childs Nerv Syst 2024; 40:2071-2079. [PMID: 38557894 PMCID: PMC11180004 DOI: 10.1007/s00381-024-06367-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 03/14/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE Placement of an external ventricular drainage (EVD) is one of the most frequent procedures in neurosurgery, but it has specific challenges and risks in the pediatric population. We here investigate the indications, management, and shunt conversion rates of an EVD. METHODS We retrospectively analyzed the data of a consecutive series of pediatric patients who had an EVD placement in the Department of Neurosurgery at Hannover Medical School over a 12-year period. A bundle approach was introduced to reduce infections. Patients were categorized according to the underlying pathology in three groups: tumor, hemorrhage, and infection. RESULTS A total of 126 patients were included in this study. Seventy-two were male, and 54 were female. The mean age at the time of EVD placement was 5.2 ± 5.0 years (range 0-17 years). The largest subgroup was the tumor group (n = 54, 42.9%), followed by the infection group (n = 47, 37.3%), including shunt infection (n = 36), infected Rickham reservoir (n = 4), and bacterial or viral cerebral infection (n = 7), and the hemorrhage group (n = 25, 19.8%). The overall complication rate was 19.8% (n = 25/126), and the total number of complications was 30. Complications during EVD placement were noted in 5/126 (4%) instances. Complications during drainage time were infection in 9.5% (12 patients), dysfunction in 7.1% (9 patients), and EVD dislocation in 3.2% (4 patients). The highest rate of complications was seen in the hemorrhage group. There were no long-term complications. Conversion rates into a permanent shunt system were 100% in previously shunt-dependent patients. Conversion rates were comparable in the tumor group (27.7%) and in the hemorrhage group (32.0%). CONCLUSION EVD placement in children is an overall safe and effective option in children. In order to make further progress, carefully planned prospective and if possible randomized studies are needed controlling for multivariable aspects.
Collapse
Affiliation(s)
- Oday Atallah
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Elvis J Hermann
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany.
| |
Collapse
|
2
|
Risk factors and outcomes associated with external ventricular drain infections. Infect Control Hosp Epidemiol 2022; 43:1859-1866. [PMID: 35471129 PMCID: PMC9753061 DOI: 10.1017/ice.2022.23] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Insertion of an external ventricular drain (EVD) is a common neurosurgical procedure which may lead to serious complications including infection. Some risk factors associated with EVD infection are well established. Others remain less certain, including specific indications for placement, prior neurosurgery, and prior EVD placement. OBJECTIVE To identify risk factors for EVD infections. METHODS We reviewed all EVD insertions at our institution from March 2015 through May 2019 following implementation of a standardized infection control protocol for EVD insertion and maintenance. Cox regression was used to identify risk factors for EVD infections. RESULTS 479 EVDs placed in 409 patients met inclusion criteria, and 9 culture-positive infections were observed during the study period. The risk of infection within 30 days of EVD placement was 2.2% (2.3 infections/1,000 EVD days). Coagulase-negative staphylococci were identified in 6 of the 9 EVD infections). EVD infection led to prolonged length of stay post-EVD-placement (23 days vs 16 days; P = .045). Cox regression demonstrated increased infection risk in patients with prior brain surgery associated with cerebrospinal fluid (CSF) diversion (HR, 8.08; 95% CI, 1.7-39.4; P = .010), CSF leak around the catheter (HR, 21.0; 95% CI, 7.0-145.1; P = .0007), and insertion site dehiscence (HR, 7.53; 95% CI, 1.04-37.1; P = .0407). Duration of EVD use >7 days was not associated with infection risk (HR, 0.62; 95% CI, 0.07-5.45; P = .669). CONCLUSION Risk factors associated with EVD infection include prior brain surgery, CSF leak, and insertion site dehiscence. We found no significant association between infection risk and duration of EVD placement.
Collapse
|
3
|
Walek KW, Leary OP, Sastry R, Asaad WF, Walsh JM, Mermel L. Decreasing External Ventricular Drain Infection Rates in the Neurocritical Care Unit: 12-Year Longitudinal Experience at a Single Institution. World Neurosurg 2021; 150:e89-e101. [PMID: 33647492 DOI: 10.1016/j.wneu.2021.02.087] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE External ventricular drain (EVD) placement is a common neurosurgical procedure, and EVD-related infection is a significant complication. We examined the effect of infection control protocol changes on EVD-related infection incidence. METHODS Changes in EVD placement protocol and incidence density of infections after implementation of protocol changes in the neurocritical care unit were tracked from 2007 to 2019. EVD infections were defined using a modified U.S. Centers for Disease Control and Prevention National Healthcare Safety Network surveillance definition of meningitis/ventriculitis for patients with EVDs in situ for at least 2 days confirmed by positive culture. Contribution of protocol changes to EVD infection risk was assessed via multivariate regression. RESULTS Fifteen major changes in EVD protocol were associated with a reduction in infections from 6.7 to 2.0 per 1000 EVD days (95% confidence interval [CI], 4.1-5.3; P < 0.001). Gram-positive bacterial infection incidence decreased from 4.8 to 1.7 per 1000 EVD days (95% CI, 2.3-3.9; P = 0.00882) and gram-negative infection incidence decreased from 1.9 to 0.5 per 1000 EVD days (95% CI, 0.6-2.3; P = 0.0303). Of all protocol changes since 2007, the largest reduction in incidence was 3.9 infections per 1000 days (95% CI, 0.50-7.30; P = 0.011), associated with combined standardization of reduced EVD sampling frequency, cutaneous antisepsis with alcoholic chlorhexidine before EVD placement, and use of a subcutaneous tunneling technique during EVD insertion. CONCLUSIONS The most significant reduction in EVD infections may be achieved through the combination of reducing EVD sampling frequency and standardizing alcoholic chlorhexidine cutaneous antisepsis and subcutaneous tunneling of the EVD catheter.
Collapse
Affiliation(s)
- Konrad W Walek
- Department of Neurosurgery, Warren Alpert Medical School of Medicine of Brown University, Providence, Rhode Island, USA
| | - Owen P Leary
- Department of Neurosurgery, Warren Alpert Medical School of Medicine of Brown University, Providence, Rhode Island, USA
| | - Rahul Sastry
- Department of Neurosurgery, Warren Alpert Medical School of Medicine of Brown University, Providence, Rhode Island, USA
| | - Wael F Asaad
- Department of Neurosurgery, Warren Alpert Medical School of Medicine of Brown University, Providence, Rhode Island, USA; Department of Neuroscience, Brown University, Providence, Rhode Island, USA; Norman Prince Neuroscience Institute, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Joan M Walsh
- Division of Critical Care, Department of Nursing, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Leonard Mermel
- Department of Medicine, Warren Alpert Medical School of Medicine of Brown University, Providence, Rhode Island, USA; Department of Epidemiology and Infection Control, Rhode Island Hospital, Providence, Rhode Island, USA; Division of Infectious Diseases, Rhode Island Hospital, Providence, Rhode Island, USA.
| |
Collapse
|
4
|
Konovalov A, Shekhtman O, Pilipenko Y, Okishev D, Ershova O, Oshorov A, Abramyan A, Kurzakova I, Eliava S. External Ventricular Drainage in Patients With Acute Aneurysmal Subarachnoid Hemorrhage After Microsurgical Clipping: Our 2006-2018 Experience and a Literature Review. Cureus 2021; 13:e12951. [PMID: 33643744 PMCID: PMC7885737 DOI: 10.7759/cureus.12951] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction The placement of an external ventricular drain (EVD) is widely practiced in neurosurgery for various diseases and conditions accompanied by impaired cerebrospinal fluid (CSF) circulation, intracranial hypertension (ICHyp), intraventricular hemorrhage (IVH), and hydrocephalus. Specialists have been using this method in patients with acute aneurysmal subarachnoid hemorrhage (aSAH) for more than 50 years. Extensive experience gained at the Burdenko Neurosurgical Center (BNC) in Moscow, the Russian Federation, in the surgical treatment of patients with acute aSAH enabled us to describe the results of using an EVD in patients after microsurgery. The objective of the research was to assess the effectiveness and safety of the EVD and clarify the indications for the microsurgical treatment of aneurysms in patients with acute SAH. Materials and methods From 2006 until the end of 2018, 645 patients registered in the BNC database underwent microsurgery for acute (0-21 days) aSAH. During the case study, we assessed the severity of hemorrhage according to the Fisher scale, the condition of patients on the Hunt-Hess (H-H) scale during surgery, the time of placement of EVD (before, during, and after surgery), and the duration of EVD. The number of patients with parenchymal intracranial pressure (ICP) transducers was assessed by the degree of correlation of ICP data through the EVD and parenchymal ICP transducer. One of the aims of the research was to compare the frequency of using EVD and decompressive craniectomy (DCH). The incidence of EVD-associated meningitis was analyzed. The need for a ventriculoperitoneal shunt (VPS) in patients after using EVD was also assessed. Overall outcomes were assessed using a modified Rankin scale (mRS) at the time of patient discharge. Exclusion criteria were as follows: patients aged less than 18 years and the lack of assessed data. Patients undergoing endovascular and conservative treatments also were excluded. Results Among the patients enrolled in the study, 22% (n=142) had EVD. Among these, 99 cases (69.7%) had EVD installed in the operating room just before the start of the surgical intervention. In some cases, ventriculostomy was performed on a delayed basis (16.3%). A satisfactory outcome (mRS scores of 1 and 2) was observed in 24.7% (n=35). Moderate and profound disability at the time of discharge was noted in 55.7% (n=79). Vegetative outcome at discharge was noted in 8.4% (n=12), and mortality occurred in 12.3% (n=15). Conclusion EVD ensures effective monitoring and reduction of ICP. EVD is associated with a relatively low risk of infectious, liquorodynamic, and hemorrhagic complications and does not worsen outcomes when used in patients with aSAH. We propose that all patients in the acute stage of SAH with H-H severity of III-V should receive EVD immediately before surgery.
Collapse
Affiliation(s)
- Anton Konovalov
- Vascular Surgery, Burdenko Neurosurgical Center, Moscow, RUS
| | - Oleg Shekhtman
- Neurosurgery, Burdenko National Medical Research Center of Neurosurgery, Moscow, RUS
| | - Yury Pilipenko
- Vascular Surgery, Burdenko National Medical Research Center of Neurosurgery, Moscow, RUS
| | - Dmitry Okishev
- Vascular Surgery, Burdenko Neurosurgical Center, Moscow, RUS
| | - Olga Ershova
- Epidemiology and Public Health, Burdenko National Medical Research Center of Neurosurgery, Moscow, RUS
| | - Andrey Oshorov
- Internal Medicine: Critical Care, Burdenko National Medical Research Center of Neurosurgery, Moscow, RUS
| | - Arevik Abramyan
- Vascular Surgery, Burdenko National Medical Research Center of Neurosurgery, Moscow, RUS
| | - Irina Kurzakova
- Vascular Surgery, Burdenko Neurosurgical Center, Moscow, RUS
| | - Shalva Eliava
- Vascular Surgery, Burdenko Neurosurgical Center, Moscow, RUS
| |
Collapse
|
5
|
Catapano JS, Rubel NC, Veljanoski D, Farber SH, Whiting AC, Morgan CD, Brigeman S, Lawton MT, Zabramski JM. Standardized Ventriculostomy Protocol without an Occlusive Dressing: Results of an Observational Study in Patients with Aneurysmal Subarachnoid Hemorrhage. World Neurosurg 2019; 131:e433-e440. [DOI: 10.1016/j.wneu.2019.07.183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/24/2019] [Accepted: 07/25/2019] [Indexed: 10/26/2022]
|
6
|
Dorresteijn KR, Jellema K, van de Beek D, Brouwer MC. Factors and measures predicting external CSF drain-associated ventriculitis. Neurology 2019; 93:964-972. [DOI: 10.1212/wnl.0000000000008552] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/29/2019] [Indexed: 12/18/2022] Open
Abstract
ObjectiveTo determine the diagnostic value of clinical factors and biochemical or microbiological measures for diagnosing a drain-associated ventriculitis, we summarized the available evidence.MethodsWe performed a systematic review and meta-analysis of studies of patients with external ventricular CSF drains who developed drain-associated ventriculitis by searching MEDLINE, EMBASE, and CENTRAL electronic database. We reported the occurrence of abnormal test results in patients with and without drain-associated ventriculitis. For continuous variables, we recalculated mean values presented in multiple studies.ResultsWe identified 42 articles published between 1984 and 2018 including 3,035 patients with external CSF drains of whom 697 (23%) developed drain-associated bacterial ventriculitis. Indications for drain placement were subarachnoid, intraventricular or cerebral hemorrhage or hemorrhage not further specified (69%), traumatic brain injury (13%), and obstructive hydrocephalus secondary to a brain tumor (10%). Fever was present in 116 of 162 patients with ventriculitis (72%) compared with 80 of 275 (29%) patients without ventriculitis. The CSF cell count was increased for 74 of 80 patients (93%) with bacterial ventriculitis and 30 of 95 patients (32%) without ventriculitis. CSF culture was positive in 125 of 156 episodes classified as ventriculitis (80%), and CSF Gram stain was positive in 44 of 81 patients (54%). In patients with ventriculitis, PCR on ribosomal RNA was positive on 54 of 78 CSF samples (69%).ConclusionClinical factors and biochemical and microbiological measures have limited diagnostic value in differentiating between ventriculitis and sterile inflammation in patients with external CSF drains. Prospective well-designed diagnostic accuracy studies in drain-associated ventriculitis are needed.
Collapse
|
7
|
Nisson PL, James WS, Gaub MB, Borgstrom M, Weinand M, Anton R. Peripheral white blood cell count as a screening tool for ventriculostomy-related infections. J Clin Neurosci 2019; 67:52-58. [PMID: 31266718 DOI: 10.1016/j.jocn.2019.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 03/28/2019] [Accepted: 06/09/2019] [Indexed: 10/26/2022]
Abstract
One of the most common complications following external ventricular drain (EVD) placement is infection. Routine cultures of cerebrospinal fluid (CSF) are often used to screen for infection, however several days may pass before infection is discovered. In this study, we compared the predictive value of daily recorded vital sign parameters and peripheral white blood count (WBC) in identifying ventriculostomy-related infections. Patients with EVDs who had CSF cultures for microorganisms performed between January 2011 and July 2017 were assigned to either an infected and/or uninfected study group. Clinical parameters were then compared using t-test, chi squared and multiple logistic regression analyses. Patients of any age and gender were included. One hundred seventy uninfected and 10 infected subjects were included in the study. Nine of the 10 infected patients had an elevated WBC (>10.4 × 103/μL), with a significantly greater WBC (15.9 × 103/μL) than the uninfected group (10.4 × 103/μL) (p-value ≤ 0.0001). Using logistic regression, we found no association between patient vital signs and CSF infection except for WBC (p = .003). As a diagnostic marker for CSF infection, the sensitivity and specificity of WBC elevation greater than 15 × 103/μL was 70% (7/10) and 90.2% (147/163), respectively. This study serves as a 'proof of concept' that WBC could be useful as potential screening tool for early detection of CSF infection post-EVD placement. Future investigation using a large, multicenter prospective study is needed to further assess the applicability of this parameter.
Collapse
Affiliation(s)
- Peyton L Nisson
- University of Arizona, College of Medicine, Tucson, AZ, United States; Department of Neurosurgery, Cedars-Sinai, Beverly Hills, CA, United States.
| | | | - Michael B Gaub
- University of Arizona, College of Medicine, Tucson, AZ, United States.
| | - Mark Borgstrom
- University Information Technology Services, University of Arizona, Tucson, AZ, United States.
| | - Martin Weinand
- University of Arizona, College of Medicine, Tucson, AZ, United States.
| | - Rein Anton
- University of Arizona, College of Medicine, Tucson, AZ, United States.
| |
Collapse
|
8
|
Diagnostic Approach to Health Care- and Device-Associated Central Nervous System Infections. J Clin Microbiol 2018; 56:JCM.00861-18. [PMID: 30135235 DOI: 10.1128/jcm.00861-18] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Health care- and device-associated central nervous system (CNS) infections have a distinct epidemiology, pathophysiology, and microbiology that require a unique diagnostic approach. Most clinical signs, symptoms, and tests used to diagnose community-acquired CNS infections are insensitive and nonspecific in neurosurgical patients due to postsurgical changes, invasive devices, prior antimicrobial exposure, and underlying CNS disease. The lack of a standardized definition of infection or diagnostic pathway has added to this challenge. In this review, we summarize the epidemiology, microbiology, and clinical presentation of these infections, discuss the issues with existing microbiologic tests, and give an overview of the current diagnostic approach.
Collapse
|
9
|
Darrow DP, Quinn C, Do TH, Hunt M, Haines S. Creation of an External Ventricular Drain Registry from a Quality Improvement Project. World Neurosurg 2018; 114:84-89. [DOI: 10.1016/j.wneu.2018.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 03/03/2018] [Indexed: 11/15/2022]
|
10
|
Strahm C, Albrich WC, Zdravkovic V, Schöbi B, Hildebrandt G, Schlegel M. Infection Rate after Cranial Neurosurgical Procedures: A Prospective Single-Center Study. World Neurosurg 2018; 111:e277-e285. [DOI: 10.1016/j.wneu.2017.12.062] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/08/2017] [Accepted: 12/09/2017] [Indexed: 10/18/2022]
|
11
|
Yuen J, Selbi W, Muquit S, Berei T. Complication rates of external ventricular drain insertion by surgeons of different experience. Ann R Coll Surg Engl 2018; 100:221-225. [PMID: 29364007 PMCID: PMC5930101 DOI: 10.1308/rcsann.2017.0221] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction Insertion of external ventricular drain (EVD) is a widely accepted, routinely performed procedure for treatment of hydrocephalus and raised intracranial pressure. The purpose of this study was to investigate whether a surgeon's experience affects the associated complication rate. Methods This retrospective study included all adult patients undergoing EVD insertion at a single centre between July 2013 and June 2015. Medical records were retrieved to obtain details on patient demographics, surgical indication, risk factors for infection and use of anticoagulants or antiplatelets. Surgeon experience, operative time, intraoperative antibiotic prophylaxis, need for revision surgery and EVD associated infection were examined. Information on catheter tip position and radiological evidence of intracranial haemorrhage was obtained from postoperative imaging. Results A total of 89 patients were included in the study. The overall infection, haemorrhage and revision rates were 4.8%, 7.8% and 13.0% respectively, with no significant difference among surgeons of different experience. The mean operating time for patients who developed an infection was 22 minutes while for those without an infection, it was 33 minutes (p=0.474). Anticoagulation/antiplatelet use did not appear to increase the rate of haemorrhage. The infection rate did not correlate with known risk factors (eg diabetes and steroids), operation start time (daytime vs out of hours) or duration of surgery although intraoperative (single dose) antibiotic prophylaxis seemed to reduce the infection rate. There was also a correlation between longer duration of catheterisation and increased risk of infection. Conclusions This is the first study demonstrating there is no significant difference in complication rates between surgeons of different experience. EVD insertion is a core neurosurgical skill and junior trainees should be trained to perform it.
Collapse
Affiliation(s)
- J Yuen
- Plymouth Hospitals NHS Trust, UK
| | - W Selbi
- Plymouth Hospitals NHS Trust, UK
| | - S Muquit
- Plymouth Hospitals NHS Trust, UK
| | - T Berei
- Plymouth Hospitals NHS Trust, UK
| |
Collapse
|
12
|
Park J, Choi YJ, Ohk B, Chang HH. Cerebrospinal Fluid Leak at Percutaneous Exit of Ventricular Catheter as a Crucial Risk Factor for External Ventricular Drainage–Related Infection in Adult Neurosurgical Patients. World Neurosurg 2018; 109:e398-e403. [DOI: 10.1016/j.wneu.2017.09.190] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 11/26/2022]
|
13
|
Multifaceted Adjunct for Prevention of Cerebrospinal Fluid Leak Following External Ventricular Drain Placement To Minimize Incidence of Infection. World Neurosurg 2017; 109:497-498. [PMID: 29232806 DOI: 10.1016/j.wneu.2017.10.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 10/21/2017] [Indexed: 11/20/2022]
|
14
|
Dąbrowski P, Jurkiewicz J, Czernicki Z, Koszewski W, Jasielski P. Polymerase chain reaction based detection of bacterial 16S rRNA gene in the cerebrospinal fluid in the diagnosis of bacterial central nervous system infection in the course of external cerebrospinal fluid drainage. Comparison with standard diagnostics currently used in clinical practice. Neurol Neurochir Pol 2017; 51:388-394. [PMID: 28743387 DOI: 10.1016/j.pjnns.2017.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 06/07/2017] [Accepted: 06/29/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND PURPOSE External drainage of cerebrospinal fluid (CSF) is a commonly used neurosurgical procedure. Complications of the procedure comprise central nervous system (CNS) bacterial infections, the frequency of which is estimated at around 6-10%. Detection of these infections is ineffective in many cases. The aim of the study was to evaluate the usefulness of a polymerase chain reaction (PCR)-based detection of bacterial 16S rRNA gene (16S rDNA) in the CSF. MATERIAL AND METHODS The study group consisted of 50 patients. Clinical signs of CNS infection were monitored and routine laboratory and microbiological tests were performed. The results of standard methods were compared with the bacterial 16S rDNA detection. RESULTS Using cultures, CNS infection was diagnosed in 8 patients, colonization of the drainage catheter in 6 patients, and sample contamination in 7 patients. In the group of the remaining 29 patients, no positive CSF culture was obtained and 13 of these patients also had all negative results for 16S rDNA detection. For the remaining 16 patients of this group, CNS infection, colonization of the catheter and sample contamination were diagnosed via PCR alone. Routine biochemical CSF tests and blood inflammatory parameters had a supporting value. CONCLUSIONS Routine hospital tests do not provide rapid and efficient detection of the external drainage related bacterial CNS infection. It is justified to use several diagnostic methods simultaneously. The16S rDNA determination in CSF can increase the probability of detection of possible pathogens.
Collapse
Affiliation(s)
- Piotr Dąbrowski
- Department of Neurosurgery, II Faculty of Medicine, Medical University of Warsaw, Poland.
| | - Jerzy Jurkiewicz
- Department of Neurosurgery, II Faculty of Medicine, Medical University of Warsaw, Poland
| | - Zbigniew Czernicki
- Department of Neurosurgery, II Faculty of Medicine, Medical University of Warsaw, Poland
| | - Waldemar Koszewski
- Department of Neurosurgery, II Faculty of Medicine, Medical University of Warsaw, Poland
| | - Piotr Jasielski
- Department of Neurosurgery, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| |
Collapse
|
15
|
Bari ME, Haider G, Malik K, Waqas M, Mahmood SF, Siddiqui M. Outcomes of post-neurosurgical ventriculostomy-associated infections. Surg Neurol Int 2017; 8:124. [PMID: 28713628 PMCID: PMC5502291 DOI: 10.4103/sni.sni_440_16] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 04/24/2017] [Indexed: 11/04/2022] Open
Abstract
Background: Ventriculostomy-associated infection (VAI) is a major concern to physicians. Limited studies have looked at the outcomes of external ventricular drain (EVD) infection and predictors of unfavorable outcomes. In this study, we assessed the outcomes of EVD infection and predictors of unfavorable outcomes. Methods: This was a retrospective medical chart review, conducted at the Aga Khan University Hospital. All the patients irrespective of age and gender, fulfilling the diagnostic criteria of VAI were included. Patients with preexisting bacterial meningitis or ventriculitis were excluded from the study. Outcome assessment was based on Glasgow outcome scale (GOS) at 1 and 3 months after procedure. Other outcomes included 30-day mortality and total length of hospital stay. Results: We included 256 patients in the study. 66 patients (25.8%) developed VAI. EVD was the primary procedure in 21 (31.8%) cases. Most patients, 24 (36.4%), had EVD as a secondary procedure for tumor surgery. Median interval between EVD placement and diagnosis of infection was 3 days. Mean length of stay in VAI patients was 31.85 ± 20.53 days. Seven patients required ICU care. Ten patients (15.2%) expired during hospital stay or within 30 days of discharge and further four had GOS of 2 or 3. A total of 52 patients had a favorable outcome after 6 months. Conclusions: Rate of VAI in this cohort was high. VAI is associated with increased morbidity, mortality, and prolonged hospital stay.
Collapse
Affiliation(s)
- Muhammad E Bari
- Section of Neurosurgery, Department of Surgery, Aga Khan University Medical College, Karachi, Pakistan
| | - Ghani Haider
- Section of Neurosurgery, Department of Surgery, Aga Khan University Medical College, Karachi, Pakistan
| | - Komail Malik
- Department of Medicine, Aga Khan University Medical College, Karachi, Pakistan
| | - Muhammad Waqas
- Section of Neurosurgery, Department of Surgery, Aga Khan University Medical College, Karachi, Pakistan
| | - Syed F Mahmood
- Section of Infectious Diseases, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | | |
Collapse
|
16
|
Flint AC, Toossi S, Chan SL, Rao VA, Sheridan W. A Simple Infection Control Protocol Durably Reduces External Ventricular Drain Infections to Near-Zero Levels. World Neurosurg 2017; 99:518-523. [DOI: 10.1016/j.wneu.2016.12.042] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 12/08/2016] [Accepted: 12/10/2016] [Indexed: 11/26/2022]
|
17
|
Tunkel AR, Hasbun R, Bhimraj A, Byers K, Kaplan SL, Scheld WM, van de Beek D, Bleck TP, Garton HJL, Zunt JR. 2017 Infectious Diseases Society of America's Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. Clin Infect Dis 2017; 64:e34-e65. [PMID: 28203777 DOI: 10.1093/cid/ciw861] [Citation(s) in RCA: 466] [Impact Index Per Article: 66.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 12/16/2016] [Indexed: 12/13/2022] Open
Abstract
The Infectious Diseases Society of America (IDSA) Standards and Practice Guidelines Committee collaborated with partner organizations to convene a panel of 10 experts on healthcare-associated ventriculitis and meningitis. The panel represented pediatric and adult specialists in the field of infectious diseases and represented other organizations whose members care for patients with healthcare-associated ventriculitis and meningitis (American Academy of Neurology, American Association of Neurological Surgeons, and Neurocritical Care Society). The panel reviewed articles based on literature reviews, review articles and book chapters, evaluated the evidence and drafted recommendations. Questions were reviewed and approved by panel members. Subcategories were included for some questions based on specific populations of patients who may develop healthcare-associated ventriculitis and meningitis after the following procedures or situations: cerebrospinal fluid shunts, cerebrospinal fluid drains, implantation of intrathecal infusion pumps, implantation of deep brain stimulation hardware, and general neurosurgery and head trauma. Recommendations were followed by the strength of the recommendation and the quality of the evidence supporting the recommendation. Many recommendations, however, were based on expert opinion because rigorous clinical data are not available. These guidelines represent a practical and useful approach to assist practicing clinicians in the management of these challenging infections.
Collapse
Affiliation(s)
- Allan R Tunkel
- Department of Internal Medicine-Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Rodrigo Hasbun
- Department of Infectious Diseases, the University of Texas Health Science Center at Houston, Texas
| | - Adarsh Bhimraj
- Department of Infectious Diseases, Cleveland Clinic, Ohio
| | - Karin Byers
- Division of Infectious Diseases, University of Pittsburgh Medical Center, Pennsylvania
| | - Sheldon L Kaplan
- Department of Pediatrics-Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas
| | - W Michael Scheld
- Division of Infectious Diseases, University of Virginia, Charlottesville
| | - Diederik van de Beek
- Department of Neurology, Academic Medical Center, Amsterdam Neuroscience, University of Amsterdam, The Netherlands
| | - Thomas P Bleck
- Departments of Neurological Sciences, Neurosurgery, Anesthesiology, and Medicine, Rush Medical College, Chicago, Illinois
| | - Hugh J L Garton
- Department of Neurological Surgery, University of Michigan, Ann Arbor; and
| | - Joseph R Zunt
- Departments of Neurology, Global Health, Medicine-Infectious Diseases, and Epidemiology, University of Washington, Seattle
| |
Collapse
|
18
|
Widén J, Eriksson BM, Ronne-Engström E, Enblad P, Westman G. Ventriculostomy-related infections in subarachnoid hemorrhage patients-a retrospective study of incidence, etiology, and antimicrobial therapy. Acta Neurochir (Wien) 2017; 159:317-323. [PMID: 27928632 PMCID: PMC5241344 DOI: 10.1007/s00701-016-3039-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 11/22/2016] [Indexed: 01/25/2023]
Abstract
BACKGROUND This study was performed to investigate the incidence and etiology of ventriculostomy-related infections (VRIs) in patients with subarachnoid hemorrhage (SAH) and to assess adherence to local clinical guidelines regarding empirical antimicrobial therapy and diagnostic routines. METHODS A total of 191 consecutive SAH patients treated in the neuro-intensive care unit of Uppsala University Hospital between 2010 and 2013 were included retrospectively. Information regarding cerebrospinal fluid samples, bacterial cultures, ventriculostomy treatment, patient characteristics, and antibiotic treatment were collected from electronic patient records. RESULTS Eleven patients developed VRI, resulting in an incidence of 5.8% per patient, 5.4% per ventriculostomy catheter, and 4.1 per 1000 catheter days. Coagulase-negative staphylococci caused nine cases of VRI and Klebsiella pneumoniae and Staphylococcus aureus caused one each. Empirical VRI therapy was initiated on 97 occasions in 81 subjects (42.4%). Out of the 11 patients with VRI, four did not receive empirical antibiotic therapy before the positive culture result. The clinical actions performed after analysis of CSF samples were in line with the action suggested by the local guidelines in 307 out of 592 cases (51.9%). CONCLUSIONS The incidence of VRI in our cohort was comparable to what has previously been reported. Coagulase-negative staphylococci was the most common agent. Our study demonstrates the difficulty in diagnosing VRI in SAH patients. Improved adherence to clinical guidelines could to some extent reduce the use of empirical antibiotic treatment, but better diagnostic methods and routines are needed.
Collapse
Affiliation(s)
- Johan Widén
- Department of Medical Sciences, Uppsala University, 751 85, Uppsala, Sweden
| | | | | | - Per Enblad
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Gabriel Westman
- Department of Medical Sciences, Uppsala University, 751 85, Uppsala, Sweden.
| |
Collapse
|
19
|
Levy ZD, Ledoux DE, Lesser ML, White T, Rosenthal JM, Johnson M, Aygok GA. Rates of iatrogenic ventriculitis before and after the use of an alcohol-impregnated external ventricular drain port cap. Am J Infect Control 2017; 45:92-93. [PMID: 27751614 DOI: 10.1016/j.ajic.2016.06.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 06/28/2016] [Accepted: 06/29/2016] [Indexed: 11/20/2022]
Abstract
Iatrogenic ventriculitis is a potential complication of ventriculostomy drain placement. In this study, an alcohol-impregnated external ventricular drain port cap was added to a standardized ventriculostomy placement bundle. Rates of ventriculitis were reduced postintervention, but this finding did not reach statistical significance.
Collapse
Affiliation(s)
- Zachary D Levy
- Department of Neurosurgery, Hofstra Northwell School of Medicine, Hempstead, NY; Department of Emergency Medicine, Hofstra Northwell School of Medicine, Hempstead, NY.
| | - David E Ledoux
- Department of Neurosurgery, Hofstra Northwell School of Medicine, Hempstead, NY
| | - Martin L Lesser
- Feinstein Institute for Medical Research, Hofstra Northwell School of Medicine, Hempstead, NY
| | | | | | - Marguerite Johnson
- Department of Infection Prevention, North Shore University Hospital, Manhasset, NY
| | - Gunes A Aygok
- Department of Neurosurgery, Hofstra Northwell School of Medicine, Hempstead, NY
| |
Collapse
|
20
|
Conen A, Fux CA, Vajkoczy P, Trampuz A. Management of infections associated with neurosurgical implanted devices. Expert Rev Anti Infect Ther 2016; 15:241-255. [PMID: 27910709 DOI: 10.1080/14787210.2017.1267563] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Neurosurgical devices are increasingly used. With it, neurosurgical device-related infections gain relevance. As biofilms are involved in implant-associated infections the diagnosis and treatment is challenging and requires specific anti-biofilm concepts and management algorithms. Areas covered: The literature concerning the management of neurosurgical device-associated infections is scarce and heterogeneous treatment concepts are discussed, but no standardized diagnostic and treatment procedures exist. Therefore, we emphasize extrapolating management strategies predominantly from orthopedic device-associated infections, where the concept is better established and clinically validated. This review covers infections associated with craniotomy fixation devices, cranioplasties, external ventricular and lumbar drainages, internal shunts and neurostimulators. Expert commentary: Sonication of the removed implants significantly improves microbiological diagnosis. A combined surgical and antimicrobial management is crucial for successful treatment: appropriate surgical intervention is combined with prolonged anti-biofilm therapy of usually 12 weeks. In selected patients, new treatment algorithms enable cure of neurosurgical device-associated infections without implant removal or with a one-stage implant exchange, considerably improving the quality of patient lives.
Collapse
Affiliation(s)
- Anna Conen
- a Clinic of Infectious Diseases and Hospital Hygiene , Department of Internal Medicine, Kantonsspital Aarau , Aarau , Switzerland
| | - Christoph A Fux
- a Clinic of Infectious Diseases and Hospital Hygiene , Department of Internal Medicine, Kantonsspital Aarau , Aarau , Switzerland
| | - Peter Vajkoczy
- b Department of Neurosurgery , Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Andrej Trampuz
- c Center for Musculoskeletal Surgery , Charité - Universitätsmedizin Berlin , Berlin , Germany
| |
Collapse
|
21
|
Chauhan S, Noor J, Yegneswaran B, Kodali H. Enterobacter Meningitis and Challenges in Treatment. J Clin Diagn Res 2016; 10:OD10-OD11. [PMID: 28208914 DOI: 10.7860/jcdr/2016/20759.9081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 08/10/2016] [Indexed: 11/24/2022]
Abstract
Neurosurgical interventions are rarely associated with meningitis with a very low incidence rate ranging from 1.1% to 2.5%. Gram negative bacillary meningitis first described in the 1940's, previously uncommon has been increasing in the recent past associated with advanced age, immunosuppression and neurosurgery. Enterobacter meningitis though relatively uncommon is recently increasing in incidence and treatment is frequently complicated due to resistance to antibiotics making this a challenging, difficult to treat infection that may be associated with adverse clinical outcomes. Here, we describe a case of a 27-year-old patient diagnosed with brain sarcoma at the age of four years, who presented with Enterobacter meningitis following a neurosurgical intervention for resection of a recurrent brain tumor (meningioma on pathology) and had a prolonged hospital stay with a difficult to treat infection.
Collapse
Affiliation(s)
- Shaylika Chauhan
- Resident Physician, Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, Saint Peter's University Hospital , New Jersey, USA
| | - Jawad Noor
- Research Assistant, Department of Pulmonology, New York Methodist , USA
| | - Balaji Yegneswaran
- Attending Physician, Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, Saint Peter's University Hospital , New Jersey, USA
| | - Hanish Kodali
- Epidemiology-Biostatistics, City University of New York , USA
| |
Collapse
|
22
|
Ventriculostomy related infection in intensive care unit: Diagnostic criteria and related conditions. JOURNAL OF ACUTE DISEASE 2016. [DOI: 10.1016/j.joad.2015.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
23
|
Mounier R, Lobo D, Cook F, Fratani A, Attias A, Martin M, Chedevergne K, Bardon J, Tazi S, Nebbad B, Bloc S, Plaud B, Dhonneur G. Clinical, biological, and microbiological pattern associated with ventriculostomy-related infection: a retrospective longitudinal study. Acta Neurochir (Wien) 2015; 157:2209-17; discussion 2217. [PMID: 26363898 DOI: 10.1007/s00701-015-2574-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 08/28/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Our aim was to describe the pattern of ventriculostomy-related infection (VRI) development using a dynamic approach. STUDY DESIGN Retrospective longitudinal study. METHODS We analyzed the files of 449 neurosurgical patients who underwent placement of external ventricular drain (EVD). During the study period, CSF sampling was performed on a daily base setting. VRI was defined as a positive CSF culture resulting in antibiotic treatment. For VRI patients, we arbitrary defined day 0 (D0) as the day antibiotic treatment was started. In these patients, we compared dynamic changes in clinical and biological parameters at four pre-determined time points: (D-4, D-3, D-2, D-1) with those of D0. For all CSF-positive cultures, we compared CSF biochemical markers' evolution pattern between VRI patients and the others, considered as a control cohort. RESULTS Thirty-two suffered from VRI. Peripheral white blood cell count did not differ between D-4-D0. Median body temperature, CSF cell count, median Glasgow Coma Scale, CSF protein, and glucose concentrations were significantly different between D-4, D-3, D-2, and D0. At D0, 100 % of CSF samples yielded organisms in culture. The physician caring for the patient decided to treat VRI based upon positive CSF culture in only 28 % (9/32) of cases. In the control cohort, CSF markers' profile trends to normalize, while it worsens in the VRI patients. CONCLUSIONS We showed that clinical symptoms and biological abnormalities of VRI evolved over time. Our data suggest that VRI decision to treat relies upon a bundle of evidence, including dynamic changes in CSF laboratory exams combined with microbiological analysis.
Collapse
|
24
|
Bayston R, Ashraf W, Ortori C. Does release of antimicrobial agents from impregnated external ventricular drainage catheters affect the diagnosis of ventriculitis? J Neurosurg 2015; 124:375-81. [PMID: 26067618 DOI: 10.3171/2014.12.jns141900] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Recently concern has arisen over the effect of released antimicrobial agents from antibiotic-impregnated external ventricular drainage (EVD) catheters on the reliability of CSF culture for diagnosis of ventriculitis. The authors designed a laboratory study to investigate this possibility, and to determine whether there was also a risk of loss of bacterial viability when CSF samples were delayed in transport to the laboratory. METHODS Three types of commercially available antibiotic-impregnated EVD catheters were perfused with a suspension of bacteria (Staphylococcus epidermidis) over 21 days. Samples were analyzed for bacterial viability and for concentrations of antibiotics released from the catheters. The authors also investigated the effect on bacterial viability in samples stored at 18°C and 4°C to simulate delay in CSF samples reaching the laboratory for analysis. RESULTS Bacterial viability was significantly reduced in all 3 catheter types when sampled on Day 1, but this effect was not observed in later samples. The results were reflected in stored samples, with significant loss of viability in Day 1 samples but with little further loss of viable bacteria in samples obtained after this time point. All samples stored for 18 hours showed significant loss of viable bacteria. CONCLUSIONS While there were differences between the catheters, only samples taken on Day 1 showed a significant reduction in the numbers of viable bacteria after passing through the catheters. This reduction coincided with higher concentrations of antimicrobial agents in the first few hours after perfusion began. Similarly, bacterial viability declined significantly after storage of Day 1 samples, but only slightly in samples obtained thereafter. The results indicate that drugs released from these antimicrobial catheters are unlikely to affect the diagnosis of ventriculitis, as sampling for this purpose is not usually conducted in the first 24 hours of EVD.
Collapse
Affiliation(s)
- Roger Bayston
- Biomaterials-Related Infection Group, School of Medicine, and
| | - Waheed Ashraf
- Biomaterials-Related Infection Group, School of Medicine, and
| | | |
Collapse
|
25
|
Ramanan M, Lipman J, Shorr A, Shankar A. A meta-analysis of ventriculostomy-associated cerebrospinal fluid infections. BMC Infect Dis 2015; 15:3. [PMID: 25567583 PMCID: PMC4300210 DOI: 10.1186/s12879-014-0712-z] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 12/11/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ventriculostomy insertion is a common neurosurgical intervention and can be complicated by ventriculostomy-associated cerebrospinal fluid infection (VAI) which is associated with increased morbidity and mortality. This meta-analysis was aimed at determining the pooled incidence rate (number per 1000 catheter-days) of VAI. METHODS Relevant studies were identified from MEDLINE and EMBASE and from reference searching of included studies and recent review articles on relevant topics. The Newcastle-Ottawa Scale was used to assess quality and risk of bias. A random effects model was used to pool individual study estimates and 95% confidence intervals (CI) were calculated using the exact Poisson method. Heterogeneity was assessed using the heterogeneity χ2 and I-squared tests. Subgroup analyses were performed and a funnel plot constructed to assess publication bias. RESULTS There were a total of 35 studies which yielded 752 infections from 66,706 catheter-days of observation. The overall pooled incidence rate of VAI was 11.4 per 1000 catheter days (95% CI 9.3 to 13.5), for high quality studies the rate was 10.6 (95% CI 8.3 to 13) and 13.5 (95% CI 8.9 to 18.1) for low quality studies. Studies which had mean duration of EVD treatment of less than 7 days had a pooled VAI rate of 19.6 per 1000 catheter-days, those with mean duration of 7-10 days had VAI rate of 12.8 per 1000 catheter-days and those with mean duration greater than 10 days had VAI rate of 8 per 1000 catheter-days. There was significant heterogeneity for the primary outcome (p = 0.004, I-squared = 44%) and most subgroups. The funnel plot did not show evidence for publication bias. CONCLUSIONS The incidence rate of VAI is 11.4 per 1000 catheter-days. Further research should focus on analysis of risk factors for VAI and techniques for reducing the rate of VAI.
Collapse
Affiliation(s)
- Mahesh Ramanan
- Burns Trauma Critical Care Research Centre, School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, 4029, Australia.
| | - Jeffrey Lipman
- Burns Trauma Critical Care Research Centre, School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, 4029, Australia.
| | - Andrew Shorr
- Medical Intensive Care Unit, Washington Hospital Center, Washington, DC, USA.
| | - Aparna Shankar
- Kempegowda Institute of Medical Sciences, Bangalore, Karnataka, India.
| |
Collapse
|
26
|
Choi SH. Prevention and Management of Extraventricular Drain-Related Ventriculitis. JOURNAL OF NEUROCRITICAL CARE 2014. [DOI: 10.18700/jnc.2014.7.2.97] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
27
|
Collins CDE, Hartley JC, Chakraborty A, Thompson DNP. Long subcutaneous tunnelling reduces infection rates in paediatric external ventricular drains. Childs Nerv Syst 2014; 30:1671-8. [PMID: 25160496 PMCID: PMC4167071 DOI: 10.1007/s00381-014-2523-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 08/04/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study is to report the efficacy of long subcutaneous tunnelling of external ventricular drains in reducing rates of infection and catheter displacement in a paediatric population. METHODS In children requiring external ventricular drainage, a long-tunnelled drain was placed and managed according to a locally agreed guideline. End points were novel CSF infection incurred during the time of drainage and re-operation to re-site displaced catheters. Data were compared to other published series. RESULTS One hundred eighty-one long-tunnelled external ventricular drains (LTEVDs) were inserted. The mean age was 6.6 years (range 0-15.5 years). Reasons for insertion included intraventricular haemorrhage (47 %), infection (27 %), tumour-related hydrocephalus (7.2 %), as a temporising measure (17 %) and trauma (2.2 %). The overall new infection rate for LTEVD was 2.76 %. If the 48 cases where LTEVDs were inserted to treat an existing infection are excluded, the infection rate was 3.8 % (5/133). The mean duration of insertion was 10 days (range 0-42 days). Four LTEVDs (2.2 %) were inadvertently dislodged, requiring reinsertion. Thirteen patients required removal of EVD alone. There was a significant difference (p < 0.05) when comparing our infection rate to 14 publications of infection rates in short-tunnelled EVDs; however, there was no difference when comparing our data to three publications using LTEVDs. CONCLUSION The use of an antibiotic-impregnated LTEVD, managed according to a predefined guideline, is associated with significantly reduced infection and displacement rates when compared with contemporary series. It is suggested that this reduction is of both clinical and economic benefits.
Collapse
|
28
|
Portillo ME, Corvec S, Borens O, Trampuz A. Propionibacterium acnes: an underestimated pathogen in implant-associated infections. BIOMED RESEARCH INTERNATIONAL 2013; 2013:804391. [PMID: 24308006 PMCID: PMC3838805 DOI: 10.1155/2013/804391] [Citation(s) in RCA: 188] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 08/20/2013] [Accepted: 10/04/2013] [Indexed: 12/16/2022]
Abstract
The role of Propionibacterium acnes in acne and in a wide range of inflammatory diseases is well established. However, P. acnes is also responsible for infections involving implants. Prolonged aerobic and anaerobic agar cultures for 14 days and broth cultures increase the detection rate. In this paper, we review the pathogenic role of P. acnes in implant-associated infections such as prosthetic joints, cardiac devices, breast implants, intraocular lenses, neurosurgical devices, and spine implants. The management of severe infections caused by P. acnes involves a combination of antimicrobial and surgical treatment (often removal of the device). Intravenous penicillin G and ceftriaxone are the first choice for serious infections, with vancomycin and daptomycin as alternatives, and amoxicillin, rifampicin, clindamycin, tetracycline, and levofloxacin for oral treatment. Sonication of explanted prosthetic material improves the diagnosis of implant-associated infections. Molecular methods may further increase the sensitivity of P. acnes detection. Coating of implants with antimicrobial substances could avoid or limit colonization of the surface and thereby reduce the risk of biofilm formation during severe infections. Our understanding of the role of P. acnes in human diseases will likely continue to increase as new associations and pathogenic mechanisms are discovered.
Collapse
Affiliation(s)
| | - Stéphane Corvec
- Service de Bactériologie-Hygiène, CHU de Nantes, Institut de Biologie, Nantes Cedex, France
- Université de Nantes, EA3826, Thérapeutiques Cliniques et Expérimentales des Infections, 1 rue G. Veil, 44000 Nantes, France
| | - Olivier Borens
- Orthopedic Septic Surgical Unit, Department of Surgery and Anesthesiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Andrej Trampuz
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Free University and Humboldt University, Charitéplatz 1, 10117 Berlin, Germany
| |
Collapse
|
29
|
Walti LN, Conen A, Coward J, Jost GF, Trampuz A. Characteristics of infections associated with external ventricular drains of cerebrospinal fluid. J Infect 2013; 66:424-31. [DOI: 10.1016/j.jinf.2012.12.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 12/26/2012] [Accepted: 12/28/2012] [Indexed: 11/25/2022]
|
30
|
Flint AC, Rao VA, Renda NC, Faigeles BS, Lasman TE, Sheridan W. A Simple Protocol to Prevent External Ventricular Drain Infections. Neurosurgery 2013; 72:993-9; discussion 999. [DOI: 10.1227/neu.0b013e31828e8dfd] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
External ventricular drains (EVDs) are associated with high rates of infection, and EVD infections cause substantial morbidity and mortality.
OBJECTIVE:
To determine whether the introduction of an evidence-based EVD infection control protocol could reduce the rate of EVD infections.
METHODS:
This was a retrospective analysis of an EVD infection control protocol introduced in a tertiary care neurointensive care unit. We compared rates of cerebrospinal fluid culture positivity and ventriculitis for the 3 years before and 3 years after the introduction of an evidence-based EVD infection control protocol. A total of 262 EVD placements were analyzed, with a total of 2499 catheter-days.
RESULTS:
The rate of cerebrospinal fluid culture positivity decreased from 9.8% (14 of 143; 11.43 per 1000 catheter-days) at baseline to 0.8% (1 of 119; 0.79 per 1000 catheter-days) in the EVD infection control protocol period (P = .001). The rate of ventriculitis decreased from 6.3% (9 of 143; 7.35 per 1000 catheter-days) to 0.8% (1 of 119; 0.79 per 1000 catheter-days; P = .02).
CONCLUSION:
The introduction of a simple, evidence-based infection control protocol was associated with a dramatic reduction in the risk of EVD infection.
Collapse
Affiliation(s)
| | - Vivek A. Rao
- Kaiser Permanente, Department of Neuroscience, Redwood City, California
| | - Natalie C. Renda
- Kaiser Permanente, Department of Neuroscience, Redwood City, California
| | | | - Todd E. Lasman
- Kaiser Permanente, Department of Neuroscience, Redwood City, California
| | - William Sheridan
- Kaiser Permanente, Department of Neuroscience, Redwood City, California
| |
Collapse
|
31
|
Infections of cerebrospinal fluid diversion devices in adults: The role of intraventricular antimicrobial therapy. J Infect 2013. [DOI: 10.1016/j.jinf.2012.11.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
32
|
Impact of antibiotic-impregnated catheters on the timing of cerebrospinal fluid infections in non-traumatic subarachnoid hemorrhage. Acta Neurochir (Wien) 2012; 154:761-6; discussion 767. [PMID: 22310970 DOI: 10.1007/s00701-012-1276-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 01/10/2012] [Indexed: 10/14/2022]
Abstract
BACKGROUND Subarachnoid hemorrhage (SAH) has been recognized as a risk factor for ventriculostomy-related infections (VRI). In addition to the hemorrhagic cerebrospinal fluid (CSF), the potential need for prolonged catheterization may contribute to the increased CSF infection rate in this population. The use of antibiotic-impregnated catheters (AIC) has effectively reduced the risk of VRI. Herein, we examined specifically the impact of systematic insertion of AIC on the timing of CSF infections in SAH patients. METHODS Retrospective review of patients admitted between April 2006 to March 2009 with a non-traumatic SAH who required an external ventriculostomy. Only patients with AIC were included. A meningitis or ventriculitis was diagnosed according to the published criteria of the Center for Disease Control and Prevention. RESULTS This study includes 75 patients in which 97 drains were inserted. Seven infections (7/75 = 9.3%) occurred over 1,024 drainage days (DD), resulting in a rate of 6.8 infections/1,000 DD. The mean drainage time was 15.4 days in the infected AIC group compared with 10.2 days in the non-infected AIC group. No infection occurred before day 9 of drainage and 71% (5/7) occurred after more than 2 weeks of drainage. The observed timing of infections is delayed in comparison with that reported in series using non-AIC, which typically occur prior to the 10th day of drainage. CONCLUSIONS In the high-risk population of non-traumatic SAH, the use of AIC delays the occurrence of infection compared with that reported with non-antibiotic-impregnated catheters. This may orient management strategies in SAH patients requiring a ventriculostomy.
Collapse
|
33
|
Pople I, Poon W, Assaker R, Mathieu D, Iantosca M, Wang E, Zhang LW, Leung G, Chumas P, Menei P, Beydon L, Hamilton M, Kamaly I, Lewis S, Ning W, Megerian JT, McGirt MJ, Murphy JA, Michael A, Meling T. Comparison of Infection Rate With the Use of Antibiotic-Impregnated vs Standard Extraventricular Drainage Devices. Neurosurgery 2012; 71:6-13. [DOI: 10.1227/neu.0b013e3182544e31] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
External ventricular drainage (EVD) catheters provide reliable and accurate means of monitoring intracranial pressure and alleviating elevated pressures via drainage of cerebrospinal fluid (CSF). CSF infections occur in approximately 9% of patients. Antibiotic-impregnated (AI) EVD catheters were developed with the goal of reducing the occurrence of EVD catheter-related CSF infections and their associated complications.
OBJECTIVE:
To present an international, prospective, randomized, open-label trial to evaluate infection incidence of AI vs standard EVD catheters.
METHODS:
Infection was defined as (1) proven infection, positive CSF culture and positive Gram stain or (2) suspected infection: (A) positive CSF culture with no organisms identified on initial Gram stain; (B) negative CSF culture with a gram-positive or -negative stain; (C) CSF leukocytosis with a white blood cell/red blood cell count >0.02.
RESULTS:
Four hundred thirty-four patients underwent implantation of an EVD catheter. One hundred seventy-six patients in the AI-EVD cohort and 181 in the standard EVD catheter cohort were eligible for evaluation of infection. The 2 groups were similar in all clinical characteristics. Proven infection was documented in 9 (2.5%) patients (AI: 4 [2.3%] vs standard: 5 [2.8%], P = 1.0). Suspected infection was documented in 31 (17.6%) patients receiving AI and 37 (20.4%) patients receiving standard EVD catheters, P = .504. Duration of time to suspected infection was prolonged in the AI cohort (8.8 ± 6.1 days) compared with the standard EVD cohort (4.6 ± 4.2 days), P = .002.
CONCLUSION:
AI-EVD catheters were associated with an extremely low rate of catheter-related infections. AI catheters were not associated with risk reduction in EVD infection compared to standard catheters. Use of AI-EVD catheters is a safe option for a wide variety of patients requiring CSF drainage and monitoring, but the efficacy of AI-EVD catheters was not supported in this trial.
Collapse
Affiliation(s)
- Ian Pople
- Frenchay Hospital, Bristol, United Kingdom
| | - Wai Poon
- Prince of Wales Hospital, Shatin, Hong Kong
| | - Richard Assaker
- Centre Hospitalier Regional Universitaire de Lille, Lille, France
| | - David Mathieu
- Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | | | | | | | | | - Paul Chumas
- Leeds General Infirmary, Leeds, United Kingdom
| | - Philippe Menei
- Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Laurent Beydon
- Centre Hospitalier Universitaire d'Angers, Angers, France
| | | | - Ian Kamaly
- Greater Manchester Neurosciences Centre, Salford, United Kingdom
| | | | | | | | | | | | | | | |
Collapse
|
34
|
The Impact of Silver Nanoparticle-Coated and Antibiotic-Impregnated External Ventricular Drainage Catheters on the Risk of Infections: A Clinical Comparison of 95 Patients. ACTA NEUROCHIRURGICA SUPPLEMENTUM 2012; 114:347-50. [DOI: 10.1007/978-3-7091-0956-4_67] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
|
35
|
Masic I, Koluder-Cimic N, Ahmetagic S, Baljic R. On the occasion of the 4th congress of infectiologists of bosnia and herzegovina with international participation. Mater Sociomed 2012; 24:20-31. [PMID: 24493992 PMCID: PMC3829089 DOI: 10.5455/msm.2012.24.s20-s31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 05/15/2012] [Indexed: 11/13/2022] Open
Abstract
The 4th Congress of Infectiologists of Bosnia-Herzegovina with international participation was held in Konjic, on 30. May to 02. June 2012. In addition to the prominent infectious disease experts from almost all university centers in B&H, the teachers at medical schools in Bosnia-Herzegovina, infectious disease specialists who work in health institutions in B&H, this Congress was attended by infectious disease experts from Serbia (12 participants), Turkey (3 participants), Croatia (3 participants), Macedonia (3 participants), Germany (2 participants) and Montenegro (2 participants). Topics included: Infections of the skin, soft tissue and bones, Sepsis and endocarditis, Infectious diseases emergencies and pediatric infectology, Emerging and reemerging infectious diseases, Hospital infections, Sexualy transmitted diseases, Infectious diagnostic and therapeutic protocols. Participating invited speakers were following professors: Salih Hosoglu (Turkey), Hakan Leblebicioglu (Turkey), Resat Ozaras (Turkey), Karsten Plötz (Germany), Ilija Kuzman (Croatia), Bruno Baršić (Croatia), Goran Tešović (Croatia). In addition to experts in infectious diseases at this Congress, their works were presented by experts from other medical disciplines, but with infectious character issues (Professors: Sead Ahmetagić, Ismet Gavrankapetanović, Zora Vukobrat-Bijedić, Senija Rašić, Halima Resić, Adnan Kapidžić, Ivo Curić, Jelena Ravlija, Amela Begić, Izet Mašić, Sadeta Hamzić, and others). Some of the papers that were presented at this Congress have been published in extenso, in the Medical Archives and Materia Socio Medica. One part as abstracts (both journals are indexed in over 10 databases), and will be electronically available to the general scientific community in Bosnia-Herzegovina, Europe and worldwide. In this way, the Bosnian infectious disease experts, as a science and profession, will be worthily represented to the colleagues from other countries in the region and beyond.
Collapse
Affiliation(s)
- Izet Masic
- On Behalf of Scientific and Organizing Committee of the 4th Congress of Infectious Diseases of Bosnia and Herzegovina with International Participation
| | - Nada Koluder-Cimic
- On Behalf of Scientific and Organizing Committee of the 4th Congress of Infectious Diseases of Bosnia and Herzegovina with International Participation
| | - Sead Ahmetagic
- On Behalf of Scientific and Organizing Committee of the 4th Congress of Infectious Diseases of Bosnia and Herzegovina with International Participation
| | - Rusmir Baljic
- On Behalf of Scientific and Organizing Committee of the 4th Congress of Infectious Diseases of Bosnia and Herzegovina with International Participation
| |
Collapse
|
36
|
Babu MA, Patel R, Marsh WR, Wijdicks EFM. Strategies to Decrease the Risk of Ventricular Catheter Infections: A Review of the Evidence. Neurocrit Care 2011; 16:194-202. [DOI: 10.1007/s12028-011-9647-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
37
|
Williams TA, Leslie GD, Dobb GJ, Roberts B, van Heerden PV. Decrease in proven ventriculitis by reducing the frequency of cerebrospinal fluid sampling from extraventricular drains. J Neurosurg 2011; 115:1040-6. [PMID: 21800964 DOI: 10.3171/2011.6.jns11167] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Ventriculitis associated with extraventricular drains (EVD) increases rates of morbidity and mortality as well as costs. Surveillance samples of CSF are taken routinely from EVD, but there is no consensus on the optimum frequency of sampling. The goal of this study was to assess whether the incidence of ventriculitis changed when CSF sampling frequency was reduced once every 3 days. METHODS After receiving institutional ethics committee approval for their project, the authors compared a prospective sample of EVD-treated patients (admitted 2008-2009) and a historical comparison group (admitted 2005-2007) at two tertiary hospital ICUs. A broad definition of ventriculitis included suspected ventriculitis (that is, treated with antibiotics for ventriculitis) and proven ventriculitis (positive CSF culture). Adult ICU patients with no preexisting neurological infection were enrolled in the study. After staff was provided with an education package, sampling of CSF was changed from daily to once every 3 days. All other management of the EVD remained unchanged. More frequent sampling was permitted if clinically indicated during the third daily sampling phase. RESULTS Two hundred seven patients were recruited during the daily sampling phase and 176 patients when sampling was reduced to once every 3 days. The Acute Physiology and Chronic Health Evaluation (APACHE) II score was lower for the daily sampling group than for the every-3rd-day group (18.6 vs 20.3, respectively; p < 0.01), but there was no difference in mean age (47 and 45 years, respectively; p = 0.14), male or female sex (61% and 59%, respectively; p = 0.68), or median EVD duration in the ICU (4.9 and 5.8 days, respectively; p = 0.14). Most patients were admitted with subarachnoid hemorrhage (42% in the daily group and 33% in the every-3rd-day group) or traumatic head injuries (29% and 36%, respectively). The incidence of ventriculitis decreased from 17% to 11% overall and for proven ventriculitis from 10% to 3% once sampling frequency was reduced. Sampling of CSF once every 3 days was independently associated with ventriculitis (OR 0.44, 95% CI 0.22-0.88, p = 0.02). CONCLUSIONS Reducing the frequency of CSF sampling to once every 3 days was associated with a significant decrease in the incidence of ventriculitis. The authors suggest that CSF sampling should therefore be performed once every 3 days in the absence of clinical indicators of ventriculitis. Reducing frequency of CSF sampling from EVDs decreased proven ventriculitis.
Collapse
Affiliation(s)
- Teresa A Williams
- Discipline of Emergency Medicine, School of Primary, Aboriginal and Rural Health Care, Nedlands, Australia.
| | | | | | | | | |
Collapse
|
38
|
|
39
|
Gigante P, Hwang BY, Appelboom G, Kellner CP, Kellner MA, Connolly ES. External ventricular drainage following aneurysmal subarachnoid haemorrhage. Br J Neurosurg 2010; 24:625-32. [DOI: 10.3109/02688697.2010.505989] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
40
|
Stevens EA, Palavecino E, Sherertz RJ, Shihabi Z, Couture DE. Effects of antibiotic-impregnated external ventricular drains on bacterial culture results: an in vitro analysis. J Neurosurg 2010; 113:86-92. [PMID: 19961313 DOI: 10.3171/2009.10.jns09565] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Treatment of ventriculoperitoneal shunt infections frequently requires placement of an external ventricular drain (EVD). Surveillance specimens obtained from antibiotic-impregnated (AI) EVDs may be less likely to demonstrate bacterial growth, potentially resulting in undertreatment of an infection. The purpose of this study was to assess whether AI EVDs had any significant effect on bacterial culture results compared with nonantibiotic-impregnated (NAI) EVDs. METHODS In vitro assays were performed using AI EVDs containing minocycline and rifampin (VentriClear II, Medtronic) and NAI EVD controls (Bioglide, Medtronic). The presence of antibiotics was evaluated via capillary electrophoresis of sterile saline drawn from AI and NAI EVDs after predefined incubation intervals. Antimicrobial activity was assessed by evaluating zones of inhibition created by the catheter aspirates on plates inoculated with a quality control strain of Staphylococcus epidermidis (American Type Culture Collection strain 12228). To determine the effects of cultures drawn through AI compared with NAI EVDs, the quality control strain was then incubated within 4 new AI and 4 new NAI EVDs for predefined intervals before being plated on culture media. Spread and streak plate culture results from each type of catheter were compared at each time interval. RESULTS Capillary electrophoresis showed that more minocycline than rifampin was eluted from the AI EVDs. Sterile saline samples incubated within the AI EVDs demonstrated zones of growth inhibition when placed on plates of S. epidermidis at all time intervals tested. No zones of inhibition were noted on NAI EVD control plates. When a standardized inoculum of S. epidermidis was drawn through AI and NAI EVDs, antimicrobial effects were observed after incubation in the AI EVD group only. Colony counting demonstrated that significantly fewer colonies resulted from samples drawn through AI compared with NAI EVDs at the multiple time intervals. Similarly, streak plating yielded a statistically significant number of false-negative results from AI compared with NAI EVDs at 2 time intervals. CONCLUSIONS The findings in the current study indicate that the risk of a false-negative culture result may be increased when a CSF sample is drawn through an AI catheter. In the management of a known shunt infection, a false-negative result from an EVD culture specimen may lead to an inappropriately short duration of antibiotic therapy. These data have significant clinical implications, particularly given the widespread use of AI drains and the current high rates of shunt reinfection after EVD use worldwide.
Collapse
Affiliation(s)
- E Andrew Stevens
- Department of Neurosurgery, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, North Carolina 27157, USA
| | | | | | | | | |
Collapse
|
41
|
Malheiros JA, Trivelato FP, Oliveira MM, Gusmão S, Cochrane DD, Steinbok P. Endoscopic choroid plexus cauterization versus ventriculoperitoneal shunt for hydranencephaly and near hydranencephaly: a prospective study. Neurosurgery 2010; 66:459-64; discussion 464. [PMID: 20173541 DOI: 10.1227/01.neu.0000365264.99133.ca] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To prospectively evaluate the results of endoscopic choroid plexus cauterization (ECPC) and ventriculoperitoneal shunts (VPSs) in infants with hydranencephaly or near hydranencephaly. METHODS We prospectively collected clinical data from all untreated hydranencephalic and near hydranencephalic children from October 2006 to March 2008. All patients treated were randomly divided into 2 groups, ECPC or VPS, and submitted to either endoscopic choroid plexus cauterization or ventriculoperitoneal shunt placement. RESULTS Seventeen patients were entered into the study. ECPC was completed in 9 patients; the procedure successfully controlled excessive head circumference and signs of increased intracranial pressure in 8 of these patients (88.8%). One endoscopic procedure in a hydranencephalic child failed after 7 months, resulting in VPS placement. Thus, of the 10 patients randomized to ECPC, 8 were treated successfully by ECPC (80%), and 2 went on to have a VPS. There were no complications related to this method of treatment. Seven children were randomized to the VPS group; and of these, 2 patients (28.5%) required shunt revisions during follow-up. There were no complications related to shunt placement. There was no difference in the success rate between patients randomized to ECPC and VPS, but the ECPC was more economical. CONCLUSION ECPC is an acceptable alternative to VPS for treatment of hydranencephaly and near hydranencephaly. It is a single, definitive, safe, effective, and economical treatment that may avoid the complications of shunting.
Collapse
Affiliation(s)
- José Augusto Malheiros
- Division of Neurosurgery, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | | | | |
Collapse
|
42
|
Efficacy of antibiotic-impregnated external ventricular drain catheters. J Clin Neurosci 2010; 17:296-8. [DOI: 10.1016/j.jocn.2009.06.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Revised: 06/11/2009] [Accepted: 06/15/2009] [Indexed: 11/23/2022]
|
43
|
Zunt JR. Infections of the central nervous system in the neurosurgical patient. HANDBOOK OF CLINICAL NEUROLOGY 2010; 96:125-141. [PMID: 20109679 DOI: 10.1016/s0072-9752(09)96009-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Joseph R Zunt
- Department of Neurology, Harborview Medical Center, Seattle, WA 98104, USA.
| |
Collapse
|
44
|
Lehto H, Dashti R, Karataş A, Niemelä M, Hernesniemi JA. THIRD VENTRICULOSTOMY THROUGH THE FENESTRATED LAMINA TERMINALIS DURING MICRONEUROSURGICAL CLIPPING OF INTRACRANIAL ANEURYSMS. Neurosurgery 2009; 64:430-4; discussion 434-5. [DOI: 10.1227/01.neu.0000338433.81852.75] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
Fenestration of the lamina terminalis (LT) is an alternative means of cerebrospinal fluid (CSF) drainage during acute or emergency surgery of ruptured intracranial aneurysms in patients with high-grade subarachnoid hemorrhage. External ventricular drainage allows drainage of CSF and also measurement of intracranial pressure after the surgery. Catheterization of the third ventricle via the fenestrated LT after clipping the aneurysm is an alternative to conventional ventriculostomies. This method has been used by the senior author (JAH) since 2001. The authors describe their experience with this technique, which can be used safely in selected cases of high-grade subarachnoid hemorrhage.
METHODS
Seventy-eight patients with aneurysmal subarachnoid hemorrhage underwent third ventriculostomy via the LT between March 2001 and December 2005. Clinical and radiological data of these consecutive patients were retrospectively reviewed.
RESULTS
There were no procedure-related complications. Eight patients (10%) later required a conventional ventriculostomy, 7 because of catheter occlusion and 1 because of catheter displacement. In 7 patients (9%), a positive CSF culture was found.
CONCLUSION
Ventriculostomy via the fenestrated LT performed during aneurysm surgery is a practical way for later CSF removal and intracranial pressure monitoring. The catheter can be applied via the same craniotomy without the need for an additional intervention. No procedure-related complications were observed in the present series. This technique can be suggested as a safe alternative to a classical ventriculostomy.
Collapse
Affiliation(s)
- Hanna Lehto
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Reza Dashti
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Ayşe Karataş
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Juha A. Hernesniemi
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| |
Collapse
|
45
|
Lackner P, Beer R, Broessner G, Helbok R, Galiano K, Pleifer C, Pfausler B, Brenneis C, Huck C, Engelhardt K, Obwegeser AA, Schmutzhard E. Efficacy of silver nanoparticles-impregnated external ventricular drain catheters in patients with acute occlusive hydrocephalus. Neurocrit Care 2008; 8:360-5. [PMID: 18320144 DOI: 10.1007/s12028-008-9071-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Catheter-associated infection of cerebrospinal fluid (CSF) is a potentially life-threatening complication of external ventricular drainage (EVD). The purpose of this pilot study was to address the efficacy of silver-impregnated EVD catheters in neurological and neurosurgical patients requiring external CSF drainage due to acute occlusive hydrocephalus. METHODS Nineteen consecutive patients were enrolled in the treatment arm of the study and data were prospectively recorded for these patients. The control group consisted of 20 patients for whom data were retrospectively assessed. CSF samples were drawn at least three times a week and routine bacterial cultures and CSF analyses were done according to standard protocols. The primary endpoint of the study was the occurrence of catheter-associated ventriculitis (CAV) proven by positive CSF culture. Secondary endpoints were bacterial colonization of the catheter tip and CSF pleocytosis. RESULTS In 20 control patients, 5 CAVs were microbiologically diagnosed. In contrast, no positive CSF cultures were found in the treatment group. This difference was statistically significant (P < 0.05). All CAVs occurred later than day 10 after catheter placement. Colonization of the catheter tip was found in 6 patients in the control group and in 5 patients in the treatment group (not significant). CONCLUSIONS This pilot study indicates that EVD catheters impregnated with silver nanoparticles might be a new option for preventing CAV in neurocritical care patients, and therefore evaluation in a large prospective randomized study is warranted.
Collapse
Affiliation(s)
- Peter Lackner
- Department of Neurology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Muttaiyah S, Ritchie S, Upton A, Roberts S. Clinical parameters do not predict infection in patients with external ventricular drains: a retrospective observational study of daily cerebrospinal fluid analysis. J Med Microbiol 2008; 57:207-209. [DOI: 10.1099/jmm.0.47518-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A retrospective review was conducted of patients with external ventricular drains (EVDs) in situ in order to ascertain the utility of daily cerebrospinal fluid (CSF) analysis in such patients. All laboratory requests for CSF analysis, which were sent to the Microbiology Department, Auckland City Hospital, New Zealand, were reviewed to identify patients with EVDs in situ. The patients' clinical records were reviewed and information was obtained regarding their age, ethnicity, indication for EVD, duration of EVD, CSF analysis results, daily temperatures, Glasgow Coma Scale (GCS) and the presence of other infections. For CSF samples that grew organisms, the patients' notes were reviewed to ascertain whether the organism was a contaminant or was representative of EVD-associated ventriculitis. A total of 454 CSF specimens from 60 patients were reviewed. Of the 56 CSF specimens that were culture-positive, 40 (71 %) were found to reflect clinical infection. Routine CSF analysis identified nine episodes of EVD-associated ventriculitis. Coagulase-negative staphylococci and Staphylococcus epidermidis were the most common isolates and were associated with ventriculitis approximately half of the time. Gram-negative isolates were less frequently isolated, but, when present, were always associated with ventriculitis. This study found that patient temperature and GCS did not allow early prediction of EVD-associated ventriculitis.
Collapse
Affiliation(s)
- Sharmini Muttaiyah
- Department of Microbiology, Auckland City Hospital, Auckland, New Zealand
| | - Stephen Ritchie
- Department of Infectious Diseases, Auckland City Hospital, Auckland, New Zealand
| | - Arlo Upton
- Department of Microbiology, Auckland City Hospital, Auckland, New Zealand
| | - Sally Roberts
- Department of Microbiology, Auckland City Hospital, Auckland, New Zealand
| |
Collapse
|
47
|
Hong JT, Son BC, Sung JH, Kim IS, Yang SH, Lee SW, Park CK. Significance of diffusion-weighted imaging and apparent diffusion coefficient maps for the evaluation of pyogenic ventriculitis. Clin Neurol Neurosurg 2008; 110:137-44. [DOI: 10.1016/j.clineuro.2007.09.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2007] [Revised: 09/28/2007] [Accepted: 09/29/2007] [Indexed: 10/22/2022]
|
48
|
Hong WC, Tu YK, Chen YS, Lien LM, Huang SJ. Subdural intracranial pressure monitoring in severe head injury: clinical experience with the Codman MicroSensor. ACTA ACUST UNITED AC 2007; 66 Suppl 2:S8-S13. [PMID: 17071260 DOI: 10.1016/j.surneu.2006.07.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2006] [Accepted: 07/24/2006] [Indexed: 02/03/2023]
Abstract
BACKGROUND Our main objective was to study the clinical outcome and complications of the subdural ICP monitoring with the CMS (Johnson and Johnson Medical Ltd, Raynhan, MA) in severe head injury. METHODS A retrospective analysis of patients with head injury with a GCS score of 8 or less was performed. Patients with severe systemic injury with hypotension (systolic blood pressure of <90 mm Hg on admission), a GCS score of 3 with fixed and dilated pupils after resuscitation, a GCS score of 3 to 4 whose family refused aggressive treatment, and those who were dead on arrival were excluded from this study. During the period from January 1997 to April 2004, 120 patients with severe head injuries were included and met criteria for insertion of a subdural ICP monitoring device (CMS). RESULTS A total of 120 patients (84 males and 36 females), aged 16 to 80 years old (mean, 43.8 +/- 14.4), were enrolled in the study. The average duration of ICP monitoring device use was 7.6 +/- 0.4 days (range, 2-14 days). The overall clinical outcomes of these patients were as follows: mortality rate, 13.5%; percentage of unfavorable outcomes, 17.3%; percentage of favorable outcomes, 69.2%. There were no complications such as CNS infection or hemorrhage in this study. CONCLUSION A subdural transducer-tipped catheter (CMS) can be used as the first-line equipment for monitoring ICP in patients with severe head injury. The clinical results are similar with other recent studies, but no complication such as infection or hemorrhage occurred in this study.
Collapse
Affiliation(s)
- Wei-Chen Hong
- Division of Neurosurgery, College of Medicine and Hospitals, National Taiwan University, Taipei, Taiwan
| | | | | | | | | |
Collapse
|
49
|
Maniker AH, Vaynman AY, Karimi RJ, Sabit AO, Holland B. Hemorrhagic complications of external ventricular drainage. Neurosurgery 2007; 59:ONS419-24; discussion ONS424-5. [PMID: 17041512 DOI: 10.1227/01.neu.0000222817.99752.e6] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Despite the widespread use of external ventricular drainage (EVD), the frequency of associated hemorrhagic complications remains unclear. This retrospective study examined the frequency of hemorrhagic complications of EVD and attempted to discern associated risk factors. METHODS Treatment records from 160 patients admitted during a 2.5-year period who required EVD placement were reviewed. Indications for placement of EVD included acute complications of cerebrovascular disease (n = 94), traumatic brain injury (n = 36), primary hydrocephalus (n = 16), and tumor (n = 14). Patients received either a 3.0 or 2.5-mm outer diameter ventricular catheter (n = 82 and 78, respectively). Postinsertion computed tomographic scans were obtained within 24 hours on all patients and were analyzed for any new hemorrhage related to the ventricular catheter. Patient age, sex, catheter type, and dimensions of hemorrhage were also analyzed. RESULTS The incidence of EVD-related hemorrhage was 33 +/- 0.04%. However, the incidence of detectable change in the clinical neurological examination was 2.5%. A significant proportion of EVD-related hemorrhages were small (<4 cm), punctate, intraparenchymal hematomas. Patients with cerebrovascular disease exhibited an increased incidence (39%) of hemorrhage. The mean volume of intraparenchymal hemorrhage was larger in patients who received the 2.5-mm ventricular catheter, as well as those admitted for cerebrovascular disease. CONCLUSION Hemorrhagic complications of EVD placement are more common than previously suspected. Admitting diagnosis seems to have an effect on the development of an associated hemorrhage and its size. Catheter gauge has an effect on hematoma volume. Most of the hemorrhages seen on postinsertion computed tomographic scans do not cause detectable changes in the clinical examination.
Collapse
Affiliation(s)
- Allen H Maniker
- University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New Jersey, USA.
| | | | | | | | | |
Collapse
|
50
|
Moon HJ, Kim SD, Lee JB, Lim DJ, Park JY. Clinical Analysis of External Ventricular Drainage Related Ventriculitis. J Korean Neurosurg Soc 2007. [DOI: 10.3340/jkns.2007.41.4.236] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Hong Joo Moon
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University School of Medicine, Ansan, Korea
| | - Sang Dae Kim
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University School of Medicine, Ansan, Korea
| | - Jang Bo Lee
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University School of Medicine, Ansan, Korea
| | - Dong Jun Lim
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University School of Medicine, Ansan, Korea
| | - Jung Yul Park
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University School of Medicine, Ansan, Korea
| |
Collapse
|