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Clinical Analysis of External Ventricular Drainage Related Ventriculitis  

Moon, Hong-Joo (Department of Neurosurgery, Korea University Ansan Hospital, Korea University School of Medicine)
Kim, Sang-Dae (Department of Neurosurgery, Korea University Ansan Hospital, Korea University School of Medicine)
Lee, Jang-Bo (Department of Neurosurgery, Korea University Ansan Hospital, Korea University School of Medicine)
Lim, Dong-Jun (Department of Neurosurgery, Korea University Ansan Hospital, Korea University School of Medicine)
Park, Jung-Yul (Department of Neurosurgery, Korea University Ansan Hospital, Korea University School of Medicine)
Publication Information
Journal of Korean Neurosurgical Society / v.41, no.4, 2007 , pp. 236-240 More about this Journal
Abstract
Objective : The aim of this study is to analyze on the external ventricular drainage [EVD] related ventriculitis, especially on their risk factors, management, and prevention. Methods : From January 2003 to December 2005, a total of 174 EVD catheters were placed in 112 patients at our institution. Of these patients, EVD-related ventriculitis were developed in 15 cases. Clinical variables such as age, sex, prior clinical diagnosis, placement of EVD insertion, duration of EVD, total numbers of EVD per person, and outcome were analyzed in theses cases to verify the risk factors, causative agents and outcomes. Results : Fifteen cases of EVD related ventriculitis were noted presenting infection incidence of 13.39 % per patient and 8.62% per procedure. Of these, five patients died from sepsis, seven patients were recovered from infection but neurological complications remained and three patients were recovered without any complications. Microbes were obtained from cerebrospinal fluid only in six patients. Acinetobactoer baumanii was the most common pathogen in our study [4 cases]. Among the various risk factors, only the prior clinical diagnosis showed the statistical significance. Patients who underwent decompressive craniectomy after severe brain trauma showed unfavorable outcome because of possible contaminative environment compared with other cases. Conclusion : EVD is considered as a safe procedure with good control of intracranial pressure if meticulous care is provided for EVD procedure and maintenance. With regards to risk factors and prevention, the higher incidence and unfavorable outcome was seen especially in patients with severe head trauma. Thus, special attention is required in these clinical settings.
Keywords
External ventricular drain; Ventriculitis; Risk factors; Management; Prevention;
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1 Poon WS, Ng S, Wai S : CSF antibiotic prophylaxis for neurosurgical patients with ventriculostomy : A randomised study. Acta Neurochir (Suppl) 71 : 146-148, 1998
2 Mayhall CG, Archer NH, Lamb VA, Spadora AC, Baggett JW, Ward JD, et al : Ventriculostomy-related infections : A prospective epidemiologic study. N Engl J Med 310 : 553-559, 1984   DOI   PUBMED   ScienceOn
3 Rosner MJ, Becker DP : ICP monitoring : complications and associated factors. Clin Neurosurg 23 : 494-519, 1976   DOI   PUBMED
4 Sim, KB, Chung CK, Kim DG, Han DH : Risk Factors of Ventriculitis following Ventriculostomy. J Korean Neurosurg Soc 23 : 553-560, 1994
5 Stenager E, Gerner-Smidt P, Kock-Jensen C : Ventriculostomy-related infections : An epidemiological study. Acta Neurochir (Wien) 83 : 20- 23, 1986   DOI
6 Sundbarg G, Nordstrom CH, Soderstrom S : Complications due to prolonged ventricular fluid pressure recording. Br J Neurosurg 2 : 485- 495, 1988   DOI
7 Wyler AR, Kelly WA : Use of antibiotics with external ventriculostomies. J Neurosurg 37 : 185-187, 1972   DOI
8 Aucoin PJ, Kotilainen HR, Gantz NM, Davidson R, Kellogg P, Stone B : Intracranial pressure monitors : epidemiologic study of risk factors and infections. Am J Med 80 : 369-376, 1986   DOI   ScienceOn
9 Hader WJ, Steinbok P : The value of routine cultures of the cerebrospinal fluid in patients with external ventricular drains. Neurosurgery 46 : 1149-1155, 2000msword,   DOI
10 Korinek AM : Risk factors for neurosurgical site infections after craniotomy : a prospective multicenter study of 2944 patients. Neurosurgery 41: 1073-1079; discussion 1079-1081, 1997   DOI
11 Rossi S, Buzzi F, Paparella A, Mainini P, Stocchetti N : Complications and safety associated with ICP monitoring : A study of 542 patients. Acta Neurochir (Suppl) 71 : 91-93, 1998   DOI
12 Clark WC, Muhlbauer MS, Lowrey R, Hartman M, Ray MW, Watridge CB : Complications of intracranial pressure monitoring in trauma patients. Neurosurgery 25 : 20-24, 1989   DOI   PUBMED
13 Holloway KL, Barnes T, Choi S, Bullock R, Marshall LF, Eisenberg HM, et al : Ventriculostomy infections : The effect of monitoring duration and catheter exchange in 584 patients. J Neurosurg 85 : 419- 424, 1996   DOI   ScienceOn
14 Guyot LL, Dowling C, Diaz FG, Michael DB : Cerebral monitoring devices : Analysis of complications. Acta Neurochir (Suppl) 71 : 47-49, 1998
15 Prabhu VC, Kaufman HH, Voelker JL, Aronoff SC, Niewiadomska- Bugaj M, Mascaro S, et al : Prophylactic antibiotics with intracranial pressure monitors and external ventricular drain s : a review of the evidence. Surg Neurol 52 : 226-236; discussion 236-237, 1999   DOI   ScienceOn
16 Kanter RK, Weiner LB, Patti AM, Robson LK : Infectious complications and duration of intracranial pressure monitoring. Crit Care Med 13 : 837-839, 1985   DOI   PUBMED   ScienceOn
17 Alleyne CH Jr, Hassan M, Zabramski JM : The efficacy and cost of prophylactic and perioprocedural antibiotics in patients with external ventricular drains. Neurosurgery 47 : 1124-1127; discussion, 1127- 1129, 2000   DOI
18 Martinez E, Rello J, Coll P : Clinical diagnosis of ventriculostomy- related infections. Lancet 344 : 1015-1016, 1994   PUBMED
19 Paramore CG, Turner DA : Relative risks of ventriculostomy infection and morbidity. Acta Neurochir (Wien) 127 : 79-84, 1994   DOI
20 Khanna RK, Rosenblum ML, Rock JP, Malik GM : Prolonged external ventricular drainage with percutaneous long-tunnel ventriculostomies. J Neurosurg 83 : 791-794, 1995   DOI   ScienceOn
21 Lyke KE, Obasanjo OO, Williams MA, O'Brien M, Chotani R, Perl TM : Ventriculitis complicating use of intraventricular catheters in adult neurosurgical patients. Clin Infect Dis 33 : 2028-2033, 2001   DOI   ScienceOn
22 Bogdahn U, Lau W, Hassel W, Gunreben G, Mertens HG, Brawanski A : Continuous-pressure controlled, external ventricular drainage for treatment of acute hydrocephalus : Evaluation of risk factors. Neurosurgery 31 : 898-904, 1992   DOI   PUBMED
23 Winfield JA, Rosenthal P, Kanter RK, Casella G : Duration of intracranial pressure monitoring does not predict daily risk of infectious complications. Neurosurgery 33 : 424-431, 1993   DOI   ScienceOn
24 Ohrstrom JK, Skou JK, Ejlertsen T, Kosteljanetz M : Bacteriology and treatment. Acta Neurochir (Wien) 100 : 67-69, 1989   DOI