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Ventriculitis complicating use of intraventricular catheters in adult neurosurgical patients. Clin Infect Dis

Division of Infectious Diseases, The Johns Hopkins University, Baltimore, MD, 21205, USA. or
Clinical Infectious Diseases (Impact Factor: 9.42). 01/2002; 33(12):2028-33. DOI: 10.1086/324492
Source: PubMed

ABSTRACT Ventriculitis is a serious complication of intraventricular catheter (IVC) use, with rates of IVC-related infections ranging from 0% to 45% and gram-positive organisms predominating. We prospectively analyzed ventriculostomy-related infections occurring among 157 adult neurosurgical patients (mean age, 54.9 years; 90 [57%] were women) from 1995 through 1998, to determine the incidence of, risk factors for, and organisms that cause ventriculitis. A total of 196 IVC events resulted in 11 infections (5.6%; 9 were caused by gram-negative organisms and 2 by coagulase-negative staphylococci). Independent risk factors for IVC-related infection include length of IVC placement (8.5 days [infected] vs. 5.1 days [uninfected]; P=.007) and cerebrospinal fluid leakage about the IVC (P=.003). The length of hospital stay (30.8 days vs. 22.6 days; P=.03) and mean total hospital charges ($85,674.27 vs. $55,339.21; P=.009) were greater for infected patients than for uninfected patients. In addition, a microbiologic shift from gram-positive organisms toward gram-negative organisms was noted. This study suggests that IVC-related infections remain serious infections that increase the length of hospitalization.

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    • "In addition, it is frequently associated with the presence of a CSF shunt, external ventricular drainage (EVD), or other intracranial device. The risk of developing a ventriculitis or meningitis with an EVD in place is reported to be as high as 45%, but more commonly it is reported in the 10% to 15% range, and it depends on the type of EVD, insertion technique, management, and length of time the EVD is in place [69] [70] [71] [72]. Hemorrhagic CSF is a risk factor for ventriculostomy-related infections , and hemorrhagic CSF likely contributes to the 10% incidence of such infections in aneurysmal subarachnoid hemorrhage patients who have EVDs, and the 13.7% incidence after intraventricular hemorrhage [71] [72] [73]. "
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    ABSTRACT: Central nervous system (CNS) infections presenting to the emergency room include meningitis, encephalitis, brain and spinal epidural abscess, subdural empyema, and ventriculitis. These conditions often require admission to an intensive care unit (ICU) and are complications of ICU patients with neurologic injury, contributing significantly to morbidity and mortality. Reducing morbidity and mortality is critically dependent on rapid diagnosis and, perhaps more importantly, on the timely initiation of appropriate antimicrobial therapy. New insights into the role of inflammation and the immune response in CNS infections have contributed to development of new diagnostic strategies using markers of inflammation, and to the study of agents with focused immunomodulatory activity, which may lead to further adjunctive therapy in human disease.
    Neurologic Clinics 06/2008; 26(2):427-68, viii. DOI:10.1016/j.ncl.2008.03.013 · 1.61 Impact Factor
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    • "In addition, it frequently is associated with the presence of a CSF shunt, external ventricular drain (EVD), or other intracranial device. The risk of developing a ventriculitis or meningitis with an EVD in place is reported to be as high as 45%, but more commonly it is reported in the 10% to 15% range, and it depends on the type of EVD, insertion technique, management, and length of time the EVD is in place [62] [63] [64] [65]. "
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    ABSTRACT: This chapter focuses on early aggressive management of common infections of the central nervous system that require monitoring in an ICU setting. These include meningitis, encephalitis, brain and epidural abscess, subdural empyema and ventriculitis. It emphasizes priorities in evaluation and management due to increasing morbidity and mortality as a result of failure to appreciate non-specific symptoms or administer timely therapy. The emergence of organisms resistant to penicillin and cephalosporins has also further complicated the early management of bacterial meningitis. Current antimicrobial guidelines are provided along with discussion of new diagnostic and therapeutic strategies and controversial aspects of management.
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    ABSTRACT: Aim The most common complication of the external ventricular drainage (EVD) is an infection, which is linked to different risk factors. We tried to investigate possible links between different risk factors and incidences of an infection of the EVD. Materials and Methods We used a retrospective method and examined records of 176 patients. These patients were admitted to the University clinical centre Maribor between January 2004–December 2005 and January 2009–December 2010 and had an EVD inserted. Results Our research had shown a high overall occurrence of infection, namely 23.3 %. We found a significantly higher incidence of infection in patients with a subarachnoid haemorrhage as an etiology. The likelihood of an infection increased with each catheter replacement and with EVDs inserted for more than 7 days. The incidence of infection in the group of patients with an impregnated catheter was significantly lower. The protective role of impregnated catheters is larger in terms of local effect and smaller in broader effect in CSF space. Conclusions An easy retrograde route for microorganisms to enter ventricular space should be prevented with appropriate wound care and by replacing EVDs only in cases of mechanical dysfunction or extraction.
    Central European Journal of Medicine 04/2012; 8(2). DOI:10.2478/s11536-012-0115-8 · 0.21 Impact Factor
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