• Acta neurochirurgica · Dec 2015

    Clinical, biological, and microbiological pattern associated with ventriculostomy-related infection: a retrospective longitudinal study.

    • Roman Mounier, David Lobo, Fabrice Cook, Alexandre Fratani, Arie Attias, Mathieu Martin, Karin Chedevergne, Jean Bardon, Sanaa Tazi, Biba Nebbad, Sébastien Bloc, Benoît Plaud, and Gilles Dhonneur.
    • Department of Anesthesia and Surgical Intensive Care, Henri Mondor University Hospital of Paris, Paris XII School of Medicine, 94000, Créteil, France. roman.mounier@laposte.net.
    • Acta Neurochir (Wien). 2015 Dec 1; 157 (12): 2209-17; discussion 2217.

    BackgroundOur aim was to describe the pattern of ventriculostomy-related infection (VRI) development using a dynamic approach.Study DesignRetrospective longitudinal study.MethodsWe 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.ResultsThirty-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.ConclusionsWe 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.

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