Complications due to Prolonged Ventricular fluid Pressure Recording

Abstract

All complications in a consecutive series of 648 patients subjected to prolonged recording of the ventricular fluid pressure (VFP) during 1982-1986 were registered and analysed. The procedure did not cause permanent symptoms or deficits in any case except for one haemorrhagic complication. Definite infections caused by the VFP recording were found in 4.3% of the 540 patients (83%) surviving their disease or lesion, and in 1.9% in non-survivors. These infections were almost exclusively registered in patients treated with prolonged drainage of hemorrhagic ventricular fluid, while definite infections in other patients were found in only 1.3%. Most infections were caused by Staphylococcus epidermidis and all infections could be treated successfully. Infection did not cause or contribute to the lethal outcome in any case. In 60% of the cases with infectious complications laboratory signs of ventriculitis occurred after a surgical revision of the ventriculostomy. The duration of VFP recording was of subordinate importance for the development of infection. In 13 patients (1.9%) during the studied period a reliable VFP recording was not obtained, a fact that points to the need for alternative methods in a minority of patients with elevated intracranial pressure. It is concluded that complications caused by VFP recording can be kept at an acceptably low frequency in patients without haemorrhagic cerebrospinal fluid demanding long-term drainage.

2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis*

“…The antimicrobial agent should be given before incision to achieve adequate tissue concentrations and should be continued for as long as 24 hours postoperatively, as studies included in these analyses generally administered therapy for this duration. With respect to CSF drain infection prevention, one review [20] that cited 10 studies addressed the use of prophylactic antimicrobials [47,68,[160][161][162][163][164][165][166][167]. One study with 102 ventriculostomies in 70 patients [165] included 44 patients who received antimicrobials and 26 who did not.…”

“…[20]. One study used a combination of a positive CSF culture with CSF pleocytosis (at least 11 WBCs/mm 3 and ≥50% neutrophils) along with clinical symptoms [68]. This definition was later refined to require 2 positive CSF cultures with the same organism on different days [51].…”

Does release of antimicrobial agents from impregnated external ventricular drainage catheters affect the diagnosis of ventriculitis?

“…4,12 The usual criteria for infection are therefore confounded by the initial pathology, and the only reliable criterion is isolation of a microorganism from the ventricular CSF drawn from the EVD catheter. 12,20 In some units CSF is routinely drawn after 3 or 5 days to check for the presence of bacteria, while in other units samples are drawn only when there is a clinical concern. 6 In recent years, antibiotic-impregnated EVD catheters have been introduced in an attempt to reduce the risk of ventriculitis arising from catheter colonization.…”

Lack of value of routine analysis of cerebrospinal fluid for prediction and diagnosis of external drainage–related bacterial meningitis

“…One of the major complications is ED-BM; reported infection rates vary between 3 and 20%. 1,4,5,9,14,15,[21][22][23] Risk factors for the development of ED-BM are duration of drainage and drain-related factors such as manipulation and site leakage. 13,20 To facilitate the diagnosis of ED-BM in patients with CSF drainage, routine analysis of CSF is often performed.…”