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Hiren C. Patel - One of the best experts on this subject based on the ideXlab platform.
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silver impregnated external Ventricular Drain related cerebrospinal fluid infections a meta analysis
Journal of Hospital Infection, 2016Co-Authors: Hiren C. Patel, R A Atkinson, L Fikrey, Andy VailAbstract:Summary Background Cerebrospinal fluid (CSF) infection is the primary complication associated with placement of an external Ventricular Drain (EVD). The use of silver-impregnated EVD catheters has become commonplace in many neurosurgical centres. Aim To assess the effect of silver-impregnated EVD catheter usage on catheter-related CSF infections. Methods A meta-analysis was performed by systematically searching Medline, Embase and the Cochrane Library. All randomized controlled trials (RCTs) and non-RCTs comparing silver-impregnated and plain EVD catheters were identified and analysed. Findings Six non-RCTs were included. The crude infection rate was 10.8% for plain catheters and 8.9% for silver-impregnated catheters [pooled odds ratio (OR) 0.71, 95% confidence interval (CI) 0.46–1.08; P = 0.11]. In a microbiological spectrum analysis, silver-impregnated catheters demonstrated a significantly lower rate of CSF infections caused by Gram-positive organisms (2.0% vs 6.7% in the silver-impregnated and plain catheter groups, respectively; pooled OR 0.27, 95% CI 0.11–0.63; P = 0.002). Conclusion The antimicrobial effects of silver-impregnated EVD catheters may be selective, and may need to be evaluated further in a prospective, controlled manner.
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External Ventricular Drain infection: improved technique can reduce infection rates.
British journal of neurosurgery, 2011Co-Authors: William J. Kitchen, Navneet Singh, Sharon Hulme, James Galea, Hiren C. Patel, Andrew KingAbstract:AbstractIntroduction. The placement of external Ventricular Drain (EVD) is a common neurosurgical procedure to Drain cerebrospinal fluid (CSF) in many acute neurosurgical conditions that disrupt the normal CSF absorption pathway. Infection is the primary complication with infection rates ranging between 0% and 45%, and this is associated with significant morbidity and mortality, prolonged hospital stay and increased hospital costs.This article compares and discusses the differences in rates of EVD CSF infection between clinical neurosurgical practice and the infection rates in a group of research patients where EVDs were sampled frequently as part of the study.Materials and methods. Patients who had EVD placed were identified by review of theatre logs from 2005–2008. A retrospective case-note review was performed with the primary end point being those patients treated with intrathecal antibiotics. Patients within the research group were identified from established data and the same primary endpoint was us...
Jeanfrancois Payen - One of the best experts on this subject based on the ideXlab platform.
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strategies to reduce external Ventricular Drain related infections a multicenter retrospective study
Journal of Neurosurgery, 2019Co-Authors: Julia Champey, Clement Mourey, Gilles Francony, P Pavese, Laurent Gergele, Romain Manet, Lionel Velly, Nicolas Bruder, Jeanfrancois PayenAbstract:OBJECTIVEVarious strategies have been proposed to reduce the incidence of external Ventricular Drain (EVD)-related infections. The authors retrospectively studied the impact of EVD care management on EVD-related infections at 3 French university hospital intensive care units.METHODSBetween 2010 and 2014, 462 consecutive adult patients with no evidence of a preexisting CSF infection received EVDs as part of their care at one of the following sites: Grenoble (221 patients), Saint-Etienne (130 patients), and Marseille (111 patients). Written protocols describing the EVD placement procedure, management, and removal were implemented at the 3 sites. Daily CSF sampling and intraVentricular administration of antibiotics prior to EVD removal were performed at the Grenoble site only. EVD-related infection was considered for any confirmed ventriculostomy-related infection (VRI) and ventriculitis. VRI was defined as one or more positive CSF cultures or Gram stain with CSF pleocytosis and biochemical abnormalities. Ventriculitis was defined as CSF pleocytosis and biochemical abnormalities with degradation of neurological status and fever.RESULTSA total of 6945 EVD days were observed in the entire population. In the Grenoble cohort, the mean cumulative incidence of EVD-related infections was significantly lower than that in the 2 other cohorts: 1.4% (95% CI 0.0%-2.9%) versus 9.2% (95% CI 4.2%-14.2%) and 7.2% (95% CI 2.4%-12.0%) at Saint-Etienne and Marseille, respectively (p < 0.01). Accounting for the duration of external Ventricular Drainage at each site, the risk for EVD-related CSF infections was significantly higher at Saint-Etienne and Marseille than at Grenoble, with ORs of 15.9 (95% CI 3.6-71.4, p < 0.001) and 10.0 (95% CI 2.2-45.5, p = 0.003), respectively.CONCLUSIONSThese findings indicate that it is possible to attain a low incidence of EVD-related infections, provided that an EVD care bundle, which can include routine daily CSF sampling, is implemented and strongly adhered to.
Silvia Figueiredo Costa - One of the best experts on this subject based on the ideXlab platform.
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infection rate and risk factors associated with infections related to external Ventricular Drain
Infection, 2011Co-Authors: Eduardo Fernandes Camacho, Icaro Boszczowski, M Basso, B C P Jeng, Maristela Pinheiro Freire, Thais Guimaraes, M J Teixeira, Silvia Figueiredo CostaAbstract:Objective To describe incidence rates and risk factors associated with external Ventricular Drain (EVD)-related infections at a tertiary Brazilian teaching hospital. Methods The patient cohort consisted of all patients at a major teaching hospital in Brazil with an EVD during the period 1 April 2007 to 30 June 2008 (15 months). Patients were followed up for 30 days after catheter removal. According to the Center for Diseases Control and Prevention criteria for meningitis/ventriculitis, all of the central nervous system (CNS) infections that occurred during this period could be considered to be meningitis or ventriculitis related to EVD placement. Infection rates were calculated using different denominators, such as (1) per patient (incidence), (2) per procedure, and (3) per 1,000 catheter-days (Drain-associated infection rate). Patient demographic data, medical history of underlying diseases, antibiotic prophylaxis usage, American Society of Anesthesiologists Score classification, duration of surgery and hospitalization, length of time the EVD was in place, and overall mortality were evaluated during the study period. A logistic regression model was developed to identify factors associated with infection. Results A total of 119 patients, 130 EVD procedures, and 839 catheter-days were evaluated. The incidence of infection was 18.3%, the infection rate was 16.9% per procedure, and the Drain-associated infection rate was 22.4 per 1,000 catheter-days; 77% of the infections were caused by Gram-negative micro-organisms. Only 75% of patients received antibiotic prophylaxis. The infection rate increased with length of the hospital stay. The length of time the catheter was in place was the only independent risk factor associated with infection (p = 0.0369). Conclusion The incidence of EVD-related infections is high in our hospital, Gram-negative micro-organisms were the most frequent causal agents identified and length of time that the catheter was in place contributed to the infection rate.
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infection rate and risk factors associated with infections related to external Ventricular Drain
Infection, 2011Co-Authors: Eduardo Fernandes Camacho, Icaro Boszczowski, M Basso, B C P Jeng, Maristela Pinheiro Freire, Thais Guimaraes, M J Teixeira, Silvia Figueiredo CostaAbstract:To describe incidence rates and risk factors associated with external Ventricular Drain (EVD)-related infections at a tertiary Brazilian teaching hospital. The patient cohort consisted of all patients at a major teaching hospital in Brazil with an EVD during the period 1 April 2007 to 30 June 2008 (15 months). Patients were followed up for 30 days after catheter removal. According to the Center for Diseases Control and Prevention criteria for meningitis/ventriculitis, all of the central nervous system (CNS) infections that occurred during this period could be considered to be meningitis or ventriculitis related to EVD placement. Infection rates were calculated using different denominators, such as (1) per patient (incidence), (2) per procedure, and (3) per 1,000 catheter-days (Drain-associated infection rate). Patient demographic data, medical history of underlying diseases, antibiotic prophylaxis usage, American Society of Anesthesiologists Score classification, duration of surgery and hospitalization, length of time the EVD was in place, and overall mortality were evaluated during the study period. A logistic regression model was developed to identify factors associated with infection. A total of 119 patients, 130 EVD procedures, and 839 catheter-days were evaluated. The incidence of infection was 18.3%, the infection rate was 16.9% per procedure, and the Drain-associated infection rate was 22.4 per 1,000 catheter-days; 77% of the infections were caused by Gram-negative micro-organisms. Only 75% of patients received antibiotic prophylaxis. The infection rate increased with length of the hospital stay. The length of time the catheter was in place was the only independent risk factor associated with infection (p = 0.0369). The incidence of EVD-related infections is high in our hospital, Gram-negative micro-organisms were the most frequent causal agents identified and length of time that the catheter was in place contributed to the infection rate.
Niklas Thon - One of the best experts on this subject based on the ideXlab platform.
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significance of cerebrospinal fluid inflammatory markers for diagnosing external Ventricular Drain associated ventriculitis in patients with severe traumatic brain injury
Neurosurgical Focus, 2019Co-Authors: Markus Lenski, Annamaria Biczok, Katrin Neufischer, Jorgchristian Tonn, J Briegel, Niklas ThonAbstract:Objective: The aim of this study was to investigate the diagnostic potential of the inflammatory markers interleukin-6 (IL-6), total leukocyte count (TLC), and protein in the CSF and IL-6, C-reactive protein, and white blood cell count in the serum for the early diagnosis of ventriculitis in patients with traumatic brain injury (TBI) and an external Ventricular Drain compared with patients without ventriculitis. Methods: Retrospective data from 40 consecutive patients with TBI and an external Ventricular Drain treated in the authors' intensive care unit between 2013 and 2017 were analyzed. For all markers, arithmetical means and standard deviations, area under the curve (AUC), cutoff values, sensitivity, specificity, positive likelihood ratio (LR), and negative LR were calculated and correlated with presence or absence of ventriculitis. Results: There were 35 patients without ventriculitis and 5 patients with ventriculitis. The mean ± SD IL-6 concentration in CSF was significantly increased, with 6519 ± 4268 pg/mL at onset of ventriculitis compared with 1065 ± 1705 pg/mL in patients without ventriculitis (p = 0.04). Regarding inflammatory markers in CSF, IL-6 showed the highest diagnostic potential for differentiation between the presence and absence of ventriculitis (AUC 0.938, cutoff 4064 pg/mL, sensitivity 100%, specificity 92.3%, positive LR 13, and negative LR 0), followed by TLC (AUC 0.900, cutoff 64.5 /µL, sensitivity 100%, specificity 80%, positive LR 5.0, and negative LR 0) and protein (AUC 0.876, cutoff 31.5 mg/dL, sensitivity 100%, specificity 62.5%, positive LR 2.7, and negative LR 0). Conclusions: The level of IL-6 in CSF has the highest diagnostic value of all investigated inflammatory markers for detecting ventriculitis in TBI patients at an early stage. In particular, CSF IL-6 levels higher than the threshold of 4064 pg/mL were significantly associated with the probability of ventriculitis.
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inflammatory markers in serum and cerebrospinal fluid for early detection of external Ventricular Drain associated ventriculitis in patients with subarachnoid hemorrhage
Journal of Neurosurgical Anesthesiology, 2019Co-Authors: Markus Lenski, Jorgchristian Tonn, J Briegel, Volker Huge, Michael Schmutzer, Moritz Ueberschaer, Christian Schichor, Niklas ThonAbstract:BACKGROUND External Ventricular Drain (EVD)-associated ventriculitis is a serious complication. Early diagnosis can be difficult particularly in critically ill patients with aneurysmal subarachnoid hemorrhage (aSAH). We examined the diagnostic potential of standard serum and cerebrospinal fluid (CSF) biomarkers to differentiate between EVD-associated infections and aseptic courses in patients with aSAH. MATERIALS AND METHODS We retrospectively evaluated the levels of inflammatory markers in serum (white blood cell count, percentage of neutrophils [sN%], and procalcitonin) and CSF (total leukocyte count [CSFTLC], CSFglucose, CSF/serumglucose ratio, CSF total protein [CSFTP]) of 63 consecutive patients with aSAH. Receiver operating characteristic curves and the area-under-the-curve (AUC) were calculated to detect the diagnostic potential, optimized threshold, sensitivity (SE), specificity (SP), + likelihood ratio (LR), and -LR of each biomarker. RESULTS Of all patients, 17 (27%) developed an EVD-associated ventriculitis within a mean of 7.8±2.3 days after implantation. sN% had a very good diagnostic potential (AUC=0.900, SE=70.0%, SP=100%), followed by the CSFTLC with good diagnostic potential (AUC=0.841, SE=75.0%, SP=88.5%), and the CSFTP with moderate diagnostic potential (AUC=0.772, SE=73.3%, SP=76.0%). sN% higher than 70% and a CSFTLC higher than 635/µL were highly associated with the diagnosis of ventriculitis (+LR=∞ and 6.5), sN%<70% or a CSFTLC<635 made a diagnosis of ventriculitis unlikely (-LR=0.3 and 0.28). CONCLUSIONS Routine determination of N% and CSFTLC are useful to distinguish ventriculitis from aseptic courses in the acute phase after aSAH and regardless of the bacteriological test result.
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role of cerebrospinal fluid markers for predicting shunt dependent hydrocephalus in patients with subarachnoid hemorrhage and external Ventricular Drain placement
World Neurosurgery, 2019Co-Authors: Markus Lenski, Annamaria Biczok, Jorgchristian Tonn, J Briegel, Volker Huge, Robert Forbrig, Niklas ThonAbstract:Objective We sought to identify potential risk factors for the development of shunt-dependent chronic hydrocephalus after aneurysmal subarachnoid hemorrhage (SAH) and external Ventricular Drain (EVD) insertion. In particular, the role of inflammatory markers within the cerebrospinal fluid (CSF) was assessed. Methods For this single-center analysis, data were generated from consecutive patients with SAH and the need for EVD implantation treated on our neurosurgical intensive care unit between 2013 and 2015. Parameters were patient characteristics (age, sex, comorbidity), severity of SAH (according to the World Federation of Neurological Society score), imaging findings (intraVentricular hemorrhage, diameter of the third ventricle, location of the ruptured aneurysm), and acute course of disease (cerebral infarction, vasospasm). Moreover, the impact of EVD Drainage volume and CSF markers (total protein [CSFTP], red blood cell count [CSFRBC], interleukin-6 [CSFIL-6], and glucose [CSFGlc]) was assessed. Statistics including receiver-operating-curve with corresponding area-under-the-curve (AUC) analysis were calculated using SPSS. Results Overall, 63 patients (21 males, mean age 55.2 years) were included. Twenty-one patients (30%) developed a shunt-dependent hydrocephalus. Significant risk factors for shunt dependency were the World Federation of Neurological Society score, cerebral infarction, and diameter of the third ventricle (P Conclusions The time course of selected inflammatory markers in CSF may support management considerations in the early phase after SAH and critical impairment of CSF circulation.
Jeffrey Lipman - One of the best experts on this subject based on the ideXlab platform.
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cerebrospinal fluid penetration of ceftolozane tazobactam in critically ill patients with an indwelling external Ventricular Drain
Antimicrobial Agents and Chemotherapy, 2020Co-Authors: Fekade B Sime, Melissa Lassigsmith, Therese Starr, Janine Stuart, Saurabh Pandey, Suzanne L Parker, Steven C Wallis, Jeffrey LipmanAbstract:The aim of this study was to describe the pharmacokinetics of ceftolozane/tazobactam in plasma and cerebrospinal fluid (CSF) of infected critically ill patients. In a prospective observational study, critically ill patients (≥ 18 years) with an indwelling external Ventricular Drain received a single intravenous dose of 3.0g ceftolozane/tazobactam. Serial plasma and CSF samples were collected for measurement of unbound ceftolozane and tazobactam concentration by liquid chromatography. Unbound concentration-time data were modelled in R using Pmetrics. Dosing simulations were performed using the final model. A three-compartment model adequately described the data from 10 patients. For ceftolozane, the median (Inter quartile range, IQR) area under the unbound concentration-time curve from time zero to infinity (fAUC0-inf) in the CSF and plasma were 30 (19-128) h*mg/L, and 323 (183-414) h*mg/L respectively. For tazobactam, these values were 5.6 (2-24) h*mg/L and 52 (36-80) h*mg/L, respectively. Mean ± standard deviation (SD) CSF penetration ratios were 0.2 ± 0.2 and 0.2±0.26 for ceftolozane and tazobactam respectively. With the 3.0 g 8-houly regimen, ≥ 0.9 probability of target attainment (PTA) for 40% fT>MIC in the CSF was possible only when MICs were ≤ 0.25 mg/L. The CSF cumulative fractional response for P. aeruginosa susceptible MIC distribution was 73%. The tazobactam PTA for the minimal suggested exposure of 20% fT>1mg/L was 12%. The current maximal dose of ceftolozane/tazobactam (3.0 g 8-hourly) does not provide adequate CSF exposure for treatment of Gram-negative meningitis or ventriculitis unless the MIC for the causative pathogen is very low (≤0.25 mg/L).
