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Ventr iculostomy related infection in intensive care unit: Diagnostic cr iter ia and related conditions
Authors: Sergio Castaño Avila´ , Esther Corral Lozano, Javier Maynar Moliner, Fernando Fonseca San Miguel, Elena Uson García,´ Yolanda Poveda Hernandez, Sara Cabañes Daro-Franc´ es, Goiatz Balziskueta Fl´ orez, Noemi Legaristi Martínez,´ Amaia Quintano Rodero, Ana Tejero Mojena, Alberto Manzano Ramírez
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Objective: To evaluate the usefulness of clinical signs, blood tests, microbiological
cultures and cerebrospinal fluid (CSF) analysis to detect ventriculostomy related infections (VRI), and to describe related conditions.
Methods: A retrospective study was carried out including all patients with external
ventricular drain admitted to intensive care unit from January 2000 to December 2006.
Diagnosis of VRI, mortality, demographic and clinical data, time and number of drains,
microbiological and biochemical CSF results and blood test were recorded. Difference
between infected and uninfected patients was statistically significant at P < 0.05.
Results: The results revealed 136 drainages in 120 patients with 22 (18.33%) infected
(15.39 infections per 1 000 days of drainage). This group was on overage older, had more
severe systemic response syndrome and a significantly higher number of drains and
longer duration of drain insertion. We found statistical differences in proteinorrachia,
glycorrhachia, and glycorrachia/glycemia ratio during 8.5-day drain insertion (interquartile range 7–10.25). A total of 31 cultures were positive in patients without VRI and
47 were negative in patients with VRI. Furthermore, 35 patients died (2 belonging to the
infected group). Significantly higher risk of VRI in intraventricular fibrinolysis and
subarachnoid haemorrhage was observed. We made a multivariate regression model
resulting in a prediction rule with 55.7% area under curve (95% CI 0.43–0.70).
Conclusions: CSF routine cultures and biochemical studies are not recommended to
diagnose VRI. Clinical signs, external ventricular drain manipulation and a drainage
insertion over a week justify the routine measurement of proteinorraquia, glycorrhachia
and the ratio of glycorrachia/glycemia.