Clinical characteristics, microbiology and outcomes of external ventricular drainage-associated infections: The importance of active treatment

Tsioutis, Constantinos; Karageorgos, Spyridon A.; Stratakou, Soultana; Soundoulounaki, Stella; Karabetsos, Dimitris; Kouyentakis, George; Gikas, Achilleas

doi:10.1016/j.jocn.2017.03.023

Cited by 9 publications

(5 citation statements)

References 24 publications

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“…Surprisingly, we did not observe Gram-negative pathogens in the cerebrospinal shunt system of children with cancer, although Gram-negative infections are common in children with cancer [ 33 , 34 ]. Our results corroborate data reported in the literature [ 14 , 25 , 26 , 30 , 33 , 34 ], where Gram-negative pathogens are more common in cerebrospinal fluid systems in children in the intensive care unit or in newborns [ 35 ].…”

Section: Discussionsupporting

confidence: 92%

Cerebrospinal Fluid System Infection in Children with Cancer: A Retrospective Analysis over 14 Years in a Major European Pediatric Cancer Center

et al. 2022

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Infection of a cerebrospinal fluid system is a serious medical complication. We performed a retrospective monocentric analysis on temporary and permanent cerebrospinal fluid devices in children with and without cancer, covering a period of over 14 years. Between 2004 and 2017, 275 children with a cerebrospinal fluid system were seen at our institution. Thirty-eight children suffered from 51 microbiologically proven infectious episodes of the cerebrospinal fluid system (12 children with cancer and 26 children without cancer). Independently of the cerebrospinal fluid system used, the incidence of infection did not significantly differ between children with and without cancer and was the highest in children younger than one year. Infection occurred earlier in external ventricular drain (EVD) than ventriculoperitoneal (VP) shunt, and in EVD significantly earlier in children with cancer compared with patients without cancer. The pathogens isolated were mainly Gram-positive bacteria, in particular Staphylococcus spp., which should be taken into account for empirical antimicrobial therapy.

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Section: Discussionsupporting

confidence: 92%

Cerebrospinal Fluid System Infection in Children with Cancer: A Retrospective Analysis over 14 Years in a Major European Pediatric Cancer Center

et al. 2022

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“…In another survey performed by Camacho et al (10), no generation of cephalosporins was superior to other generations. Tsioutis et al (19) reported that Gram-negative bacteria (GNB) predominated (57.9%) in the EVDs infection, followed by Gram-positive (36.8%) and fungi (5.3%). The current study had limitations, including not considering culture results when diagnosing the infection, because of the high prevalence of false-negative reports.…”

Section: Discussionmentioning

confidence: 99%

Is External Ventricular Drain Infection Predictable in Neurosurgery Patients? A Following-up Study in Iran

et al. 2021

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Background: External ventricular drains (EVDs) infection is a life-threatening complication. Objectives: To investigate the rate of EVDs infection and its predictive factors in neurosurgery patients hospitalized at a tertiary teaching hospital in Iran. Methods: In this survey, all patients referred to a subspecialty hospital in Tehran (Iran) with an external ventricular drain (EVDs) from Jun 23, 2018, to Jun 23, 2019, are monitored within 30 days of EVDs placement for infection. Data on demographic information, underlying diseases, number of EVD replacements, length of hospital stay, type consumed antibiotic before neurosurgery, length of tunneling, type of airway, duration of mechanical ventilation, duration of surgery(hours), surgeon name, APACHE II score, length of intensive care unit stay are collected. The diagnosis was based on the Center for Diseases Control and Prevention criteria for meningitis/ventriculitis and clinical vision of infectious or critical care specialists. A logistic regression model was developed to identify factors that can predict the infection. Results: Of 81 patients with EVDs, 39 (48.1%) were infected. The mean age of patients was 44.33 ± 19.5 years, and 55.6% of them were male. According to the multiple logistic regression analysis, mechanical ventilation for more than 6 days (OR: 2.5, 95% CI: 1.6 - 3.56, P = 0.04) and length of tunneling > 5 cm (OR: 1.98, 95%CI: 1.87 - 4.76, P = 0.02) were identified as factors that could predict EVD infection. Also, consuming ceftazidime + vancomycin, as a prophylaxis agent, had a lower odds ratio for EVD infection (OR:0.4, 95% CI: 0.08 - 0.84, P = 0.04). Conclusions: Regarding the predictive factors of EVDs infection, either in the present study or other studies, there should be strategies to manage this life-threatening infection in neurosurgery patients.

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“…Bazı çalışmalarda ise Stafilokkus aureus en sık etken olarak gözükmektedir (1,2,13). Özellikle EVDK ilişkili menenjitlerde stafilokokların (Staphylococcus epidermidis ve S. aureus) en sık etken olması beklenmekte, ancak Gram-negatif bakterilerin insidansında artış olduğu görülmektedir (9,24). Ayrıca morbidite ve mortalitesi yüksek olan dirençli A. baumaii menenjitlerinin insidansı gün geçtikçe artmaktadır (2,10).…”

Section: Discussionunclassified

“…Bu çalışmalarda kortikosteroid kullanımı, EVDK ve tekrarlayan cerrahi girişimlerin kraniyotomi sonrası menenjit gelişme riskini arttırdığı ortaya konmuştur. EVDK ile ilişkili NKM'lerde etken olarak koagülaz negatif stafilokoklar ön plandayken bazı hasta serilerinde Gram-negatif bakteriler daha fazla izole edilmiştir (8,9). Kraniyotomi sonrasında gelişen NKM'lerde Gram-negatif basiller ve Stafiloccusus aureus en fazla izole edilen etkenlerdir (10).…”

Section: Introductionunclassified

The Effects of Corticosteroid Use on Prognosis of Patients with Nosocomial Meningitis in Neurosurgical Intensive Care Unit: A Retrospective Descriptive Study

Akçıl¹,

Dilmen²,

Gönen³

et al. 2018

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Beyin cerrahisi yoğun bakım hastalarında kraniyotomiler, eksternal ventrikül drenaj kateteri gibi invaziv uygulamalar ve penetran kafa travmaları nozokomiyal menenjit gelişme riskini arttırmaktadır. Kortikosteroid kullanımının da bu riski arttırdığını gösteren çalışmalar olduğu gibi tersini savunan çalışmalar da bulunmaktadır. Bu retrospektif tanımlayıcı çalışmanın amacı 5 yıl süresince beyin cerrahisi yoğun bakım ünitesinde nozokomiyal menenjit gelişen hastalarda kortikosteroid kullanımının mortalite, nozokomiyal enfeksiyon, cerrahi girişim sayısı ve yoğun bakım yatış süresi üzerine etkisini ortaya koymaktır. Gereç ve Yöntem: Bu çalışmada 5 yıllık sürede beyin cerrahisi yoğun bakım ünitesinde yatan 2228 hastadan nozokomiyal menenjit gelişen 13 olgu retrospektif olarak incelendi. Nozokomiyal menenjit gelişen hastalarda kortikosteroid kullanımının mortalite, nozokomiyal enfeksiyon, cerrahi girişim sayısı ve yoğun bakım yatış süresi üzerine etkisi araştırılmıştır. Bulgular: Kortikosteroid kullanımının nozokomiyal menenjiti olan hastalarda mortalite, nozokomiyal enfeksiyon riski, cerrahi girişim sayısı ve yoğun bakım yatış süresi üzerine etkisi bulunmadı (p>0,05). Sonuç: Nozokomiyal menenjiti olan beyin cerrahisi yoğun bakım hastalarında, kortikosteroid kullanımı; mortalite, nozokomiyal enfeksiyon riski, cerrahi girişim sayısı ve yoğun bakım yatış süresini etkilememektedir. Anahtar Kelimeler: Nozokomiyal menenjit, kortikosteroidler, beyin cerrahisi yoğun bakım ünitesi ABSTRACT Objective: Invasive procedures such as craniotomies, external ventricular drainage catheters, and penetrating head traumas increase the risk of nosocomial meningitis in neurosurgical intensive care unit patients. While some studies suggest that corticosteroids increase this risk, others argue no such effect present. The aim of this retrospective descriptive study was to reveal the effect of corticosteroid use in patients with nosocomial meningitis in the neurosurgical intensive care unit for five years on mortality, nosocomial infection, the number of surgical interventions and the duration of stay in intensive care unit. Materials and Methods: In this study, 13 cases that developed nosocomial meningitis from 2228 patients in the neurosurgical intensive care unit during a 5-year period were retrospectively analyzed. The effects of corticosteroid use on mortality, nosocomial infections, number of surgical interventions and length of stay in intensive care unit were investigated in patients with nosocomial meningitis. Results: The use of corticosteroid in patients with nosocomial meningitis had no effect on mortality, nosocomial infection risk, number of surgical interventions and length of stay in intensive care unit (p>0.05). Conclusion: Corticosteroid use of neurosurgical intensive care unit patients with nosocomial meningitis does not affect mortality, nosocomial infection risk, number of surgical interventions and length of stay in intensive care unit.

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Clinical characteristics, microbiology and outcomes of external ventricular drainage-associated infections: The importance of active treatment

Cited by 9 publications

References 24 publications

Cerebrospinal Fluid System Infection in Children with Cancer: A Retrospective Analysis over 14 Years in a Major European Pediatric Cancer Center

Cerebrospinal Fluid System Infection in Children with Cancer: A Retrospective Analysis over 14 Years in a Major European Pediatric Cancer Center

Is External Ventricular Drain Infection Predictable in Neurosurgery Patients? A Following-up Study in Iran

The Effects of Corticosteroid Use on Prognosis of Patients with Nosocomial Meningitis in Neurosurgical Intensive Care Unit: A Retrospective Descriptive Study

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