Natural history of ventriculostomy-related infection under appropriate treatment and risk factors of poor outcome: a retrospective study

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OBJECTIVE

The authors aimed to describe the natural history of ventriculostomy-related infections (VRIs) under appropriate treatment and to assess risk factors for poor outcome.

METHODS

All patients older than 18 years in whom an external ventricular drain (EVD) had been implanted and who had developed a VRI requiring treatment were included in this retrospective study. D0 was defined as the first day of antibiotic administration. Clinical and biological parameters were compared each day beginning with D1 and ending with D10 to those of D0. The authors defined D0 in a control group as the day a CSF culture came back positive, without any sign of infection. The authors then searched for poor prognostic factors in the VRI group.

RESULTS

Among 567 patients requiring an EVD between January 2007 and October 2017, 39 developed a VRI. Most were monomicrobial infections, and 47 microbes were responsible (45% were gram-positive cocci). Clinical parameters differed significantly from the control group during the first 2 days and then returned to baseline. The CSF parameters differed significantly from the control group for a longer period, returning to baseline after 5 days. CSF sterilization occurred in a median time of 2 days. An intrathecal route or EVD exchange was not associated with a poor outcome. No clinical or biological parameter between D3 and D5 was linked to outcome.

CONCLUSIONS

Clinical status improved faster than CSF parameters (before and after D5, respectively). Some CSF parameters remained abnormal until D10. Body temperature and microbiological cultures normalized faster than other parameters.

ABBREVIATIONS ESBL = extended-spectrum beta-lactamase; EVD = external ventricular drain; GCS = Glasgow Coma Scale; GNR = gram-negative rods; GOS = Glasgow Outcome Scale; GOSE = GOS-Extended; GPC = gram-positive cocci; GS = Gram staining; IDSA = Infectious Diseases Society of America; SAH = subarachnoid hemorrhage; VRC = ventriculostomy-related colonization; VRI = ventriculostomy-related infection; WBC = white blood cell.
Article Information

Contributor Notes

Correspondence Roman Mounier: Henri Mondor University Hospital, Créteil, France. roman.mounier@laposte.net.INCLUDE WHEN CITING Published online November 16, 2018; DOI: 10.3171/2018.6.JNS18853.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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