Corrected white blood cell count, cell index, and validation of a clinical model for the diagnosis of health care-associated ventriculitis and meningitis in adults with intracranial hemorrhage

Montes, Kevin; Jenkinson, Helena; Habib, Onaizah; Esquenazi, Yoshua; Hasbun, Rodrigo

doi:10.1016/j.clineuro.2019.01.012

Cited by 17 publications

(13 citation statements)

References 14 publications

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“…A literature review resulted in mixed results as to the usefulness of this measure. 10,11,17 In a study of 34 patients with either SAH or TBI, Lunardi et al found that using an absolute cutoff point for Cell Index at 2.9 had a sensitivity of 95% and a specificity of 92.9% for detecting VRI, with an area under the receiver operating curve of 0.982. 17 However, when analyzing subgroups, this group was unable to draw firm conclusions on patients with TBI alone.…”

Section: Discussionmentioning

confidence: 99%

“…The Cell Index (CI) was defined as the WBC/RBC ratio in CSF divided by the WBC/RBC ratio in whole blood. 10,11 Because whole blood RBC was rarely measured, an approximation formula was created based on hemoglobin values, which were measured daily (for derivation, please refer to the Supplementum). This approximated CI differed by an average of 2.6% (range 0.010%-10.74%) from the true value in twenty patients who had concomitant measurements of hemoglobin and RBC (Supplemental Table S2).…”

Section: Calculationsmentioning

confidence: 99%

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Diagnostic criteria of CNS infection in patients with external ventricular drainage after traumatic brain injury: a pilot study

Willer-Hansen

Olsen

Hauerberg

et al. 2022

Acta Anaesthesiol Scand

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Background: Ventriculostomy-related infection (VRI) is a common complication in patients with traumatic brain injury (TBI) treated with an external ventricular drain (EVD). The aim of this study was to investigate incidence and characteristics of patients with VRI, and to explore diagnostic criteria to confidently rule out VRI in patients with TBI.Methods: This retrospective cohort pilot study included adults with severe TBI who were admitted to the ICU and received an EVD, during a 26-month period. Patients were categorized as having Culture-positive VRI, Culture-negative VRI, or No VRI.Variables that were potentially associated with Culture-positive VRI was analyzed, and predictive values were calculated.Results: 75 of 215 patients with severe TBI (35%) underwent EVD placement; nine of these (12%) were classified as Culture-negative VRI and eight (11%) as Culture-positive VRI. The CSF cell counts that led to VRI treatment were compared with 46 CSF cell counts from No VRI patients. A CSF/plasma glucose ratio below 0.6 had a negative predictive value (NPV) for culture-verified VRI of 0.97 (95% CI: 0.85-1), whereas a combination of three CSF-derived biomarkers within the reference limits (white/red blood cell ratio, CSF/plasma glucose ratio, and protein content) ruled out Culturepositive VRI in this cohort (PPV 0, 95% CI: 0-0.14). C-reactive protein did not reliably predict VRI. Conclusions:In this pilot study of patients after severe, a combination of biomarkers within reference limits ruled out VRI (PPV 0, CI: 0-0.14). Hypoglycorrhachia was a sensitive marker of VRI (NPV 0.97, CI: 0.85-1). Systemic signs and markers of infection did not predict VRI.

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Section: Discussionmentioning

confidence: 99%

Section: Calculationsmentioning

confidence: 99%

Diagnostic criteria of CNS infection in patients with external ventricular drainage after traumatic brain injury: a pilot study

Willer-Hansen

Olsen

Hauerberg

et al. 2022

Acta Anaesthesiol Scand

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“…In previously reported studies, the AUC of the cell index ranged from 0.63 to 0.83, which was comparable with the diagnostic accuracy of the noncorrected leukocyte count. 7-9…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Clinical Signs and Biochemical Parameters for External Ventricular CSF Catheter-Associated Infection

et al. 2022

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Background and ObjectivesFew prospective well-designed diagnostic accuracy studies have been performed to study the parameters of infection in patients suspected for external ventricular catheter-associated infection. Our objective was to analyze the diagnostic accuracy of clinical characteristics and biochemical and microbiological parameters in diagnosing external ventricular CSF catheter-associated infection.MethodsFrom 2014 to 2017, we performed a single-center cohort study in consecutive patients at the intensive care unit who required an external ventricular CSF catheter in the Hague, the Netherlands. CSF was sampled and analyzed daily. Ventricular catheter-associated infection was defined according to the 2017 Infectious Diseases Society of America's Clinical Practice Guidelines. We compared clinical characteristics and biochemical parameters between patients with and without infection from 3 days before to 3 days after the day the CSF sample was collected that grew bacteria.ResultsA total of 103 patients were included of whom 15 developed a catheter-associated infection (15%). The median day cultures were positive was 3 days after CSF collection (interquartile range [IQR] +2 to +4). On day 0, none of the tests could differentiate between patients with and without infection. The CSF leukocyte count was increased in patients with ventricular catheter-associated infection as compared with patients without on days +2 and +3. The difference was most prominent on day +2 (1,703 × 106/L [IQR 480–6,296] vs 80 × 106/L [IQR 27–251]; p < 0.001; area under the curve [AUC] 0.87 [95% confidence interval (CI) 0.71–1.00]). Sensitivity for the CSF leukocyte count at a cutoff level >1,000 × 106/L was 67% (95% CI 30–93), and specificity was 100% (95% CI 90–100); the positive predictive value was 100%, and the negative predictive value was 92% (95% CI 83–97). The percentage of polymorphonuclear cells (PMNs) was higher in patients with infection on days +1 and +2 (day +2 89% [IQR 78–94] vs 59% [IQR 39–75]; p < 0.01; AUC 0.91 [95% CI 0.81–1.0]).DiscussionAn elevated CSF leukocyte count and increased percentage of PMNs are the strongest indicators for external catheter-associated infections on the days before culture positivity. New CSF markers of drain-associated infection should be studied to enable earlier diagnosis and treatment in patients with an infection and reduce antibiotic treatment in those with no infection.Classification of EvidenceThis study provides Class I evidence that in individuals requiring an external ventricular CSF catheter, an elevated CSF leukocyte count and an increased percentage of PMNs are the strongest indicators of catheter-associated infections in the days before CSF culture positivity.

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“…For CSF lactate, studies have shown cutoff values between 1.9 and 5.4 mmol/L to diagnose bacterial meningitis, but no single standard exists and not all data are conclusive, especially when a ventriculostomy is in place [35]. The cell index, assessing CSF cell counts in relation to serum counts, has been reported to have some value in diagnosing HAMV, even though the most convincing data (area under the curve of 0.825) for infection in hospitalized patients with ICH were documented in the setting of positive CSF culture [36]. Some experts suggest different, not yet validated, algorithms such as consideration of bacterial meningitis as unlikely with normal CSF glucose, CSF lactate < 4 mmol/L and negative Gram stain [10•].…”

Section: Diagnosismentioning

confidence: 99%

Healthcare-Associated Infections in the Neurocritical Care Unit

Busl

2019

Curr Neurol Neurosci Rep

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Purpose of Review This article summarizes updated data and knowledge on healthcare-associated infections in the neurocritical care unit, with a focus on central nervous system infections and systemic infectious complications in patients with acute brain disease. It also reviews the concept of brain injury-induced immune modulation, an underlying mechanism to explain why the neuro-ICU population is particularly susceptible to infections. Recent Findings Healthcare-associated infections in the neuro-ICU are common: up to 40 % of meningitides in the developed world are now healthcare-associated. The number of gram-negative infections is rising. New diagnostic approaches attempt to aid in the diagnosis of healthcare-associated meningitis and ventriculitis. Summary Healthcare-associated infections in the neurocritical care unit remain a challenge for diagnosis, treatment, and prevention. Gaining a better understanding of at-risk patients and development of preventative strategies will be the goal for future investigation.

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Corrected white blood cell count, cell index, and validation of a clinical model for the diagnosis of health care-associated ventriculitis and meningitis in adults with intracranial hemorrhage

Cited by 17 publications

References 14 publications

Diagnostic criteria of CNS infection in patients with external ventricular drainage after traumatic brain injury: a pilot study

Diagnostic criteria of CNS infection in patients with external ventricular drainage after traumatic brain injury: a pilot study

Diagnostic Accuracy of Clinical Signs and Biochemical Parameters for External Ventricular CSF Catheter-Associated Infection

Healthcare-Associated Infections in the Neurocritical Care Unit

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