Surveillance of infection associated with external ventricular drains: proposed methodology and results from a pilot study

Humphreys, Hilary; Jenks, Peter J.; Wilson, Jennie; Weston, Vivienne; Bayston, Roger; Waterhouse, Catheryne; Moore, Anita C.

doi:10.1016/j.jhin.2016.09.008

Cited by 24 publications

(6 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…During an IC intervention to improve staff adherence to IC practices, we observed that the infection rate decreased from 17.3 per 1000 drain days before the intervention to 7.9/1000 after the intervention. Our rate of EVD-related meningitis specifically, during and following the intervention period (9.5-8.6/1000 EVD days), was in the low range of rates in previous studies reporting on EVD-related meningitis per catheter day (4.8-17.2/1000 EVD days) in the UK and Ireland [12], Russia [27], and Switzerland [32]. In the analysis per patient, patientrelated factors dominated, while the effect of the IC intervention was observed in the analysis per catheter.…”

Section: Discussioncontrasting

confidence: 55%

See 1 more Smart Citation

Risk factors for meningitis in neurosurgical patients with cerebrospinal fluid drains: prospective observational cohort study

et al. 2019

View full text Add to dashboard Cite

Background Cerebrospinal fluid (CSF) drainage or intracranial pressure (ICP) monitoring devices are life-saving devices. We examined the risk factors for infections related to them and assessed the effect of an infection control (IC) intervention. Methods A prospective observational study was conducted in the Neurosurgical Department of our hospital between 2014 and 2017. We included all consecutive patients undergoing CSF catheter insertions, including external ventricular drainage (EVD), lumbar drainage (LD), and ICP catheters. An IC intervention was implemented between March and August 2016. We examined risk factors for meningitis or ventriculitis, defined according to Healthcare-associated infections surveillance definitions, on univariate and multivariate analysis. Results A total of 232 patients with 437 drains (212 EVDs, 92 LDs, and 133 ICPs) were included. On univariate and multivariate analysis, the infection incidence was 13.7 per 1000 drain days (17.3/1000 before IC intervention, 7.9/1000 during, and 9.2/1000 after the intervention). Most episodes were caused by Gram-negative bacteria, and the most common pathogen was Acinetobacter baumanii. Risk factors for infection per patient included diabetes mellitus (p = 0.017), CSF leak (p = 0.032), drain opening (p = 0.027), and the duration of the drain in days (p = 0.035). Risk factors per catheter included drain opening (p < 0.001), drain days (p = 0.001), and the IC intervention period compared to before the intervention period (p = 0.037). When restricting the analysis to EVDs, drain days (p = 0.001) was the only significant risk factor. Conclusions Strict adherence to IC, shortening drain duration, and avoiding unnecessary opening and manipulation of the drains are crucial to preventing neurosurgical drain infections.

show abstract

Section: Discussioncontrasting

confidence: 55%

“…The estimated ventriculostomy-related infection incidence rates range between 0 and 27% [9,12,22,26,28], the wide range being both real and artefactual due to differences in infection definitions. A few previous studies have addressed LD-related infection and rates ranging from 3 to 10% [28,29].…”

Section: Introductionmentioning

confidence: 99%

Risk factors for meningitis in neurosurgical patients with cerebrospinal fluid drains: prospective observational cohort study

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Ventriculitis most commonly occurs as a complication of external ventricular drains or in patients with ventricular shunts used to relieve increased intracranial pressure associated with hydrocephalus. Such infections are not uncommon (infection rate of ventricular-catheter raising up to 20% in some series) and are caused by microorganisms involved in foreign body infections such as staphylococci or antibiotic resistant Gram-negative bacilli [ 1 – 3 ] .…”

Section: Backgoundmentioning

confidence: 99%

Primary bacterial ventriculitis in adults, an emergent diagnosis challenge: report of a meningoccal case and review of the literature

et al. 2018

View full text Add to dashboard Cite

BackgroundDefined by an infection of the ventricular system of the brain, ventriculitis is usually known as a health-care associated infection. In contrast, primary pyogenic ventriculitis complicating community-acquired meningitis is uncommon, and mainly described in infants. Only seven cases that have occured in adults have been found in the international literature.Case presentationWe report here a new case due to Neisseria meningitidis occurring in an 85 year-old-man. The comparison with previous reports allows to drawn several conclusions: (i) cases occurred in relatively old adults (median age: 65 years); (ii) Streptococcus pneumoniae, N. meningitiditis and Staphylococcus aureus are the leading responsible pathogens; (iii) atypical clinical presentation seems the rule in which meningism often lacks; (iv) in absence of clinical or biological specific parameters, modern brain imaging such as magnetic resonance imaging with gadolinium enhancement is of utmost importance for the diagnosis, leading to anticipate an increase of the diagnosis in the near future, thanks to easier access to such exploration; (v) death or serious sequelae commonly occurred; (vi) prolonged antibiotic courses (6 weeks to 3 months) have been used, without strong rational. In the given case, the patient presented with a lack of meningeal irritation signs. The diagnosis was made by MRI considering a lasting confused state. A four-week antibiotic regimen was successful, combining two weeks of intravenous cefotaxime followed by two weeks of oral levofloxacin much easier to administrate and allowing early rehabilitation.ConclusionPrimary bacterial ventriculitis is a real diagnosis challenge. Larger indications of MRI for bacterial meningitis, particularly in cases with an atypical presentation or poor evolution would certainly increase the number of diagnosis.

show abstract

“…External ventricular drain External ventricular drain (EVD)-associated bacterial ventriculitis is a frequent complication in patients with EVDs [1][2][3]. EVDs are used in neurocritical care units for monitoring of intracranial pressure, intrathecal drug administration, or drainage of cerebrospinal fluid (CSF).…”

Section: Introductionmentioning

confidence: 99%

Population pharmacokinetics of vancomycin in patients with external ventricular drain‐associated ventriculitis

Jalusic

Hempel

Arnemann

et al. 2020

Brit J Clinical Pharma

View full text Add to dashboard Cite

show abstract

Surveillance of infection associated with external ventricular drains: proposed methodology and results from a pilot study

Cited by 24 publications

References 22 publications

Risk factors for meningitis in neurosurgical patients with cerebrospinal fluid drains: prospective observational cohort study

Risk factors for meningitis in neurosurgical patients with cerebrospinal fluid drains: prospective observational cohort study

Primary bacterial ventriculitis in adults, an emergent diagnosis challenge: report of a meningoccal case and review of the literature

Population pharmacokinetics of vancomycin in patients with external ventricular drain‐associated ventriculitis

Contact Info

Product

Resources

About