Clinical and Laboratory Characteristics for the Diagnosis of Bacterial Ventriculitis After Aneurysmal Subarachnoid Hemorrhage

Abstract

BackgroundThe diagnosis of nosocomial bacterial ventriculitis in patients with subarachnoid hemorrhage (SAH) can be challenging.Methods We performed a retrospective study on the diagnostic accuracy of clinical and laboratory characteristics for the diagnosis of bacterial ventriculitis in 209 consecutive patients with an aneurysmal SAH admitted in a tertiary referral center from 2008 to 2010. Diagnostic value of clinical characteristics and inflammatory indexes in CSF and blood were determined for three diagnostic categories: (1) no suspicion for bacterial ventriculitis; (2) clinical suspicion for bacterial ventriculitis, defined as initiation of empirical antibiotic treatment for ventriculitis, but negative CSF cultures; and (3) CSF culture-positive bacterial ventriculitis. ResultsEmpirical antibiotics for suspected ventriculitis was initiated in 48 of 209 (23 %) patients. CSF cultures were positive in 11 (5 %) patients. Within the group of suspected ventriculitis, only longer duration of CSF drainage and lower CSF red blood cell counts predicted for culture positivity. None of the other clinical features or inflammatory indexes in CSF and blood were associated with culture-proven bacterial ventriculitis.ConclusionsNosocomial bacterial ventriculitis in patients with aneurysmal SAH is often suspected but confirmed by culture in a minority of cases. Improvement of diagnostics for nosocomial bacterial ventriculitis in patients with aneurysmal SAH is needed.

Significance of cerebrospinal fluid inflammatory markers for diagnosing external ventricular drain–associated ventriculitis in patients with severe traumatic brain injury

“…detection of ventriculitis after SAH, 9 the diagnostic potential of inflammatory reactions in serum and CSF for the detection of ventriculitis after TBI has not yet been objectively assessed. Based on our experience with patients with SAH, 14,15 we aimed to investigate whether the interleukin-6 (IL-6) level in CSF in particular may be useful for the early detection of bacterial ventriculitis after TBI and placement of an EVD.…”

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

“…In a recent study from the Netherlands, 48 of 209 patients with suspected ventriculitis (23%) were started on empirical antibiotics after subarachnoid haemorrhage. 7 However, in only 11 patients (5%) were the CSF cultures positive. A high red blood cell count in the CSF, as might perhaps be expected in this group of patients, was statistically associated with CSF culture-negative cases.…”

“…A high red blood cell count in the CSF, as might perhaps be expected in this group of patients, was statistically associated with CSF culture-negative cases. 7 While the greater availability of molecular methods to diagnose VDRV may assist in determining the microbial cause, there will always be a need to assess a combination of clinical features, microbiological results, and other CSF parameters such as a protein levels, glucose levels, and cell counts. Surveillance definitions, however, should allow for the complex nature of this condition and the difficulties in being certain of the diagnosis.…”

“…This often means that more patients with suspected ventriculitis or meningitis are empirically treated than are subsequently confirmed to have the infection. In a recent study from the Netherlands, 48 of 209 patients with suspected ventriculitis (23%) were started on empirical antibiotics after subarachnoid haemorrhage 7 . However, in only 11 patients (5%) were the CSF cultures positive.…”

Infectious complications of aneurysmal subarachnoid hemorrhage

“…Пневмонія, інфекція сечовивідних шляхів і нейроінфекція переважають серед інфекційних ускладнень у пацієнтів з аневризматичним САК. За даними літератури, пневмонія трапляється в 12,8-23,0 % випадків (у нашому дослідженні -в 19,2 %), iнфекції сечовивідних шляхів -у 9-23 % (у нашому дослідженні -в 14,4 %) [9,10], менінгіт або вентрикуліт -у 3-5 % (у нашому дослідженні -в 2,9 %) [11,12].…”