Post craniotomy extra-ventricular drain (EVD) associated nosocomial meningitis: CSF diagnostic criteria

Munoz-Gomez, Sigridh; Wirkowski, Elizabeth; Cunha, Burke A.

doi:10.1016/j.hrtlng.2015.01.003

Cited by 19 publications

(9 citation statements)

References 15 publications

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“…Previous studies [ 36 , 37 ] reported that in the patients with EVD placement, the risk of infection increases with the duration of EVD, which is consistent with the findings of this study. At the same time, the retention of EVD and the duration extension of drainage increase the risk of exposure to a certain extent [ 38 ]. Moreover, failure to aseptic operations and improper EVD care may cause intracranial infection, suggesting that EVD use should be highlighted in clinical setting [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

RETRACTED ARTICLE: The risk factors of intracranial infection in patients with intracerebral hemorrhage undergone hematoma puncture: what should we care

Han¹,

Yu²,

Liu³

et al. 2020

BMC Infect Dis

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Background Intracranial infection after puncture of cerebral hematoma in patients with intracerebral hemorrhage is very common in the department of neurosurgery, yet the relevant risks remain unknown. We attempted to analyze the risk factors of intracranial infection after puncture of cerebral hematoma, to provide insights into the management of patients with intracerebral hemorrhage after puncture of cerebral hematoma. Methods Patients with intracerebral hemorrhage after puncture of cerebral hematoma treated in our hospital from January 2017 to January 2020 were selected, the related characteristics of intracranial infection and no infection patients were compared. Logistic regression analyses were conducted to analyze the risk factors for intracranial infection after puncture of cerebral hematoma. Results A total of 925 patients with puncture of cerebral hematoma were included. The incidence of postoperative intracranial infection was 7.03%. There were significant statistical differences between the infected group and the no infection group in the American Association of Anesthesiologists (ASA) grade, length of hospital stay, consecutive operation, duration of surgery, extra-ventricular drainage (EVD) use (all p < 0.05). There was statistically significant difference in the duration of EVD between the infection and no infection groups (p = 0.002), and there was no significant difference in the frequency of EVD insertion between the two groups (p = 0.094). The length of hospital stay≥10 days (OR1.832, 1.062–3.158), consecutive operation (OR2.158, 1.358–3.430), duration of surgery≥4 h (OR1.581, 1.031–2.425), EVD use (OR1.694, 1.074–2.670), and duration of EVD ≥ 7 days (OR2.699, 1.689–4.311) were the risk factors of intracranial infection in patients with intracerebral hemorrhage after puncture of cerebral hematoma (all p < 0.05). Conclusion Clinical medical workers should take corresponding preventive measures against the different risk factors for prevention of intracranial infection in patient with puncture of cerebral hematoma.

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Section: Discussionmentioning

confidence: 99%

RETRACTED ARTICLE: The risk factors of intracranial infection in patients with intracerebral hemorrhage undergone hematoma puncture: what should we care

Han¹,

Yu²,

Liu³

et al. 2020

BMC Infect Dis

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“…CSF analysis is unavoidably skewed by the clinical decision to sample, and the equipoise examined can remain after the initial CSF cell counts are available while definitive microbiological culture is awaited. This is indicative of the real-world clinical difficulty, unlike that examined in many studies which seek to diagnose nosocomial infection either purely on the basis of CSF examination, the sampling timing of which is not clear relative to the diagnostic equipoise ( Beer et al , 2008 ; Muñoz-Gómez et al , 2015 ; Sorinola et al , 2019 ; Zheng et al , 2020 ) or later purely on a limited number of biomarkers analysed post hoc ( van Mourik et al , 2012 , 2015 ). The multiple pathologies we encountered are also reflective of clinical practice where the ultimate goal is to achieve diagnostic resolution of nosocomial infection against the complete spectrum of non-infective aetiologies encountered in neurosurgical and neurological care.…”

Section: Discussionmentioning

confidence: 99%

Toll-like receptor linked cytokine profiles in cerebrospinal fluid discriminate neurological infection from sterile inflammation

Cuff

Merola

Twohig

et al. 2020

Brain Communications

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Rapid determination of an infective aetiology causing neurological inflammation in the cerebrospinal fluid can be challenging in clinical practice. Post-surgical nosocomial infection is difficult to diagnose accurately, as it occurs on a background of altered cerebrospinal fluid composition due to the underlying pathologies and surgical procedures involved. There is additional diagnostic difficulty after external ventricular drain or ventriculoperitoneal shunt surgery, as infection is often caused by pathogens growing as biofilms, which may fail to elicit a significant inflammatory response and are challenging to identify by microbiological culture. Despite much research effort, a single sensitive and specific cerebrospinal fluid biomarker has yet to be defined which reliably distinguishes infective from non-infective inflammation. As a result, many patients with suspected infection are treated empirically with broad-spectrum antibiotics in the absence of definitive diagnostic criteria. To begin to address these issues, we examined cerebrospinal fluid taken at the point of clinical equipoise to diagnose cerebrospinal fluid infection in 14 consecutive neurosurgical patients showing signs of inflammatory complications. Using the guidelines of the Infectious Diseases Society of America, six cases were subsequently characterized as infected and eight as sterile inflammation. Twenty-four contemporaneous patients with idiopathic intracranial hypertension or normal pressure hydrocephalus were included as non-inflamed controls. We measured 182 immune and neurological biomarkers in each sample and used pathway analysis to elucidate the biological underpinnings of any biomarker changes. Increased levels of the inflammatory cytokine interleukin-6 and interleukin-6-related mediators such as oncostatin M were excellent indicators of inflammation. However, interleukin-6 levels alone could not distinguish between bacterially infected and uninfected patients. Within the patient cohort with neurological inflammation, a pattern of raised interleukin-17, interleukin-12p40/p70 and interleukin-23 levels delineated nosocomial bacteriological infection from background neuroinflammation. Pathway analysis showed that the observed immune signatures could be explained through a common generic inflammatory response marked by interleukin-6 in both nosocomial and non-infectious inflammation, overlaid with a toll-like receptor-associated and bacterial peptidoglycan-triggered interleukin-17 pathway response that occurred exclusively during infection. This is the first demonstration of a pathway dependent cerebrospinal fluid biomarker differentiation distinguishing nosocomial infection from background neuroinflammation. It is especially relevant to the commonly encountered pathologies in clinical practice, such as subarachnoid haemorrhage and post-cranial neurosurgery. While requiring confirmation in a larger cohort, the current data indicate the potential utility of cerebrospinal fluid biomarker strategies to identify differential initiation of a common downstream interleukin-6 pathway to diagnose nosocomial infection in this challenging clinical cohort.

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“… 25 The previous studies presented neurosurgical interventions, prolonged duration of lumbar or ventricular drainage, head trauma, and CSF leakage as the important risk factors for MEN. 26 , 27 , 28 , 29 …”

Section: Discussionmentioning

confidence: 99%

Risk factors of mortality in nosocomial infected traumatic patients in a trauma referral center in south of Iran

Yadollahi

Kashkooe

Feyzi

et al. 2018

Chinese Journal of Traumatology

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PurposeTrauma-related injuries are the leading cause of death worldwide. Some risk factors make traumatic patients susceptible to infection. Furthermore, some mortality risk factors, including length of hospitalization and increasing age, were detected in non-traumatic infected patients. This study aimed to assess mortality risk factors among nosocomial infected traumatic patients in Rajaee trauma center, Shiraz, Iran.MethodsThis prospective cohort study was conducted during a period of 2 years since April 2015 to March 2017 in Rajaee hospital, which is the center of emergency medical services for traumatic injuries in Shiraz, Iran. Centers for Disease Control and Prevention/National Healthcare Safety Network surveillance system criteria were applied to define 5 types of nosocomial infections. The variables analyzed as the risk factors of infection and mortality included sex, age, mechanism of injury, site of injury, injury severity score (ISS), surgical intervention, length of hospitalization, intensive care unit (ICU) admission, and type of pathogen. Then, the incidence of nosocomial infection and also risk factors of mortality in traumatic patients were evaluated. All data analyses were performed using the statistical package for social sciences, version 15 (SPSS Inc., Chicago) and p ≤ 0.05 is considered to be statistically significant.ResultsThe incidence of nosocomial infection was 7.2% (p < 0.001). Pneumonia was the most common type of infection detected in our study. Infection led to a 7.8-fold increase in mortality of the traumatic patients (p < 0.001). Admission in intensive care units and old age were the main risk factors of mortality in infected traumatic patients. Old age, gunshot and motor vehicle accidents, trauma to extremities and abdomen, higher injury severity score, and prolonged hospitalization, made the traumatic patients more susceptible to infection.ConclusionThe really high incidence of nosocomial infection in traumatic patients in Iran depends on some risk factors that should be considered. Also infection increases the mortality rate in the traumatic patients, which could be reduced by eliminating its risk factors.

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Post craniotomy extra-ventricular drain (EVD) associated nosocomial meningitis: CSF diagnostic criteria

Cited by 19 publications

References 15 publications

RETRACTED ARTICLE: The risk factors of intracranial infection in patients with intracerebral hemorrhage undergone hematoma puncture: what should we care

RETRACTED ARTICLE: The risk factors of intracranial infection in patients with intracerebral hemorrhage undergone hematoma puncture: what should we care

Toll-like receptor linked cytokine profiles in cerebrospinal fluid discriminate neurological infection from sterile inflammation

Risk factors of mortality in nosocomial infected traumatic patients in a trauma referral center in south of Iran

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