Diagnosing external ventricular drain-related ventriculitis by means of local inflammatory response: soluble triggering receptor expressed on myeloid cells-1

Abstract

IntroductionExternal ventricular drainage (EVD)-related ventriculitis is one of the most severe complications associated with the use of EVDs. Establishing an early and certain diagnosis can be difficult in critically ill patients. We performed this prospective study to evaluate the usefulness of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) determination in cerebrospinal fluid (CSF) in the diagnosis of ventriculitis.MethodsA prospective observational study was conducted of 73 consecutive patients with EVD. Samples of CSF for culture, cytobiochemical analysis and sTREM-1 determination were extracted three times a week. Ventriculitis diagnosis required a combination of microbiological, cytobiochemical and clinical criteria.ResultsSeventy-three consecutive patients were included. EVD-related ventriculitis was diagnosed in six patients and EVD-colonization in ten patients. Patients without clinical or microbiological findings were considered controls. The median CSF sTREM-1 was 4,320 pg/ml (interquartile range (IQR): 2,987 to 4,886) versus 266 pg/ml (118 to 689); P <0.001. There were no differences when comparing colonized-patients and controls. The best cut-off sTREM-1 value for the diagnosis of ventriculitis was 2,388.79 pg/ml (sensitivity 100%, specificity 98.5%, positive predictive value 85.71%, negative predictive value 100%). CSF proteins, glucose and the ratio CSF/serum glucose were also significantly different (P = 0.001). Serum biomarkers were not useful to diagnose EVD-related infection. These results were confirmed by a case–control study with ventriculitis patients (cases) and non-ventriculitis (control subjects) matched by age, comorbidities, severity scales and EVD duration (P = 0.004).ConclusionsCSF sTREM-1 was useful in the diagnosis of ventriculitis, in a similar measure to classical CSF parameters. Furthermore, CSF sTREM-1 could prove the diagnosis in uncertain cases and discriminate between EVD-colonization and infection.

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

“…This finding is in line with those of previous reports. 7,15 Two studies confirmed significantly increased TLC in patients with ventriculitis, but results regarding glucose, protein, and percentage of neutrophils in CSF or serum markers WBCC and CRP were not conclusive. 17,34 Another recently published study showed that the cell index (ratio of leukocytes to erythrocytes in CSF and leukocytes to erythrocytes in the peripheral blood) had a good diagnostic potential for predicting ventriculitis.…”

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

“…Other substrates, such as CSF lactate, cytokine levels, and serum procalcitonin, are also disturbed after SAH. Although procalcitonin has been shown to be able to discriminate between a systemic inflammatory response syndrome and a systemic infection [34], the value to differentiate between aseptic and bacterial ventriculitis of this and other substrates is limited [33–38]. Polymerase chain reaction of the CSF for the detection of bacterial pathogens has been shown to have a low sensitivity in patients with an external catheter-related bacterial ventriculitis and patients with aseptic ventriculitis after surgery, but assays are getting more sensitive [39–42].…”

External ventricular drainage-related ventriculitis

“…Debido a estos factores, el estudio de LCR sigue siendo la clave para el diagnóstico de ventriculitis. Sin embargo, la irritación meníngea debido a la presencia de productos de degradación en la sangre podría (10) afectar glucosa, proteínas y mediciones de recuento de leucocitos en el LCR . Por todo esto no se puede establecer un valor absoluto de parámetros citoquímicos para indicar o sospechar infección.…”

“…Los bacilos Gram negativos son una etiología creciente que complican las posibilidades terapéuticas dada su (1,(12)(13)(14)(15) estrecha relación con multirresistencia . Actualmente hay muchas publicaciones en donde los (1,5,10,12) gérmenes más frecuentes son los bacilos Gram negativos .…”

“…Los bacilos Gram negativos son una etiología creciente que complican las posibilidades terapéuticas dada su (1,(12)(13)(14)(15) estrecha relación con multirresistencia . Actualmente hay muchas publicaciones en donde los (1,5,10,12) gérmenes más frecuentes son los bacilos Gram negativos .La infección asociada a ventriculostomía debe considerarse como serio factor que contribuye a la morbilidad y mortalidad en estos pacientes, por tanto es imprescindible conocer la prevalencia y los factores de riesgo que contribuyen a su aparición. Además se ha comprobado que cada vez más los microorganismos aislados son multirresistentes, situación que complica el manejo terapéutico, prolonga la estancia hospitalaria y aumenta los gastos.…”