Early diagnosis of external ventricular drainage infection: results of a prospective study

Abstract

Objectives: The aim of this study was to evaluate the influence of total drainage time on the risk of catheter infection, and the predictive value of standard laboratory examinations for the diagnosis of bacteriologically recorded cerebrospinal fluid (CSF) infection during external ventricular drainage. Methods: During a three year period, all patients of the neurosurgical intensive care unit (ICU), who received an external ventricular drain, were prospectivly studied. Daily CSF samples were obtained and examined for cell count, glucose and protein content. Bacteriological cultures were taken three times a week, and serum sepsis parameters were determined. Results: 130 patients received a total of 186 external ventricular drains. The ventricular catheters were in place from one to 25 days (mean 7.1 days). In 1343 days of drainage, the authors recorded 41 positive bacteriological cultures in 21 patients between the first and the 22nd drainage day (mean 6.4). No significant correlation was found between drainage time and positive CSF culture. The only parameter that significantly correlated with the occurrence of a positive CSF culture was the CSF cell count (unpaired t test, p<0.05). Conclusions: Drainage time is not a significant risk factor for catheter infection. Increasing CSF cell count should lead to the suspicion of bacteriological drainage contamination. Other standard laboratory parameters, such as peripheral leucocyte count, CSF glucose, CSF protein, or serum sepsis parameters, are not reliable predictors for incipient ventricular catheter infection.

Infections of external ventricular drainages

“…In one of the study it was demonstrated that hemorrhagic CSF -as a consequence of SAH or intraventricular hemorrhage (IVH) -occurred four times more frequently with a group of infected patients compared to the non-infected group [15]. Additionally the potential effect of SAH and IVH on the infection rate was mentioned in some of the later studies [7,[16][17][18][19]. Within our study the correlation between SAH and higher incidence of infections proved to be significant.…”

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

“…Pfisterer and colleagues 18 performed a transversal analysis of CSF results for 130 patients with external drainage from whom daily CSF samples were obtained. The leukocyte counts were heterogeneous in both the patient group and the control group.…”

Untitled

“…Existe farta literatura sobre as complicações infecciosas 1,3,4,[9][10][11]15,18 , mas o assunto foge aos objetivos deste trabalho. Entretanto, a literatura sobre os problemas mecânicos de bolsas de drenagem é relativamente escassa, talvez porquê o mais grave deles, que é a hiperdrenagem liquórica, ocorra devido ao manuseio incorreto do sistema de derivação externa, e talvez esse fato não seja comum em países desenvolvidos, mas ocorre com freqüência em países de terceiro mundo.…”