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Erik Kronvall - One of the best experts on this subject based on the ideXlab platform.
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Silver-Coated Ventriculostomy Catheters Do Not Reduce Rates of Clinically Diagnosed Ventriculitis.
World Neurosurgery, 2018Co-Authors: Anna Nilsson, Erik Uvelius, David Cederberg, Erik KronvallAbstract:Background Ventriculitis is a serious complication when using external ventricular drains (EVDs). Bactericidal silver coating has been reported to reduce risk of infection. In the clinical setting, the diagnosis is often made based on symptoms and analyses of cerebrospinal fluid, with treatment initiated before infection is verified by culture. The bactericidal effect might not correlate with a reduced rate of clinically diagnosed infections. This retrospective study aimed to analyze if use of silver-coated EVDs is associated with a reduced rate of Ventriculitis. Methods During 1 year, clinical routine was changed from inserting noncoated catheters to silver-coated catheters. Rate of Ventriculitis was compared between patient groups based on catheter type. To examine the clinical impact of silver coating, Ventriculitis was defined as cases where antibiotic treatment was initiated on clinical suspicion. Results Among 296 patients (186 noncoated and 110 silver-coated catheters), 18.9% were treated for Ventriculitis, with 21.0% in the noncoated group and 15.5% in the silver-coated group (P = 0.242). Silver coating did not reduce the rate of positive cultures. Duration of EVD treatment was the single significant risk factor for Ventriculitis. Silver-coated catheters did not reduce the need for cerebrospinal fluid shunt placement, days with antibiotics, days with EVD, or days in the intensive care unit. Conclusions The previously reported bactericidal effect of silver-coated EVDs did not alter the clinical course to significantly reduce the number of treated cases of Ventriculitis. The introduction of silver-coated EVDs cannot be motivated by reduced use of antibiotics or shorter hospital stay.
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Silver-Coated Ventriculostomy Catheters Do Not Reduce Rates of Clinically Diagnosed Ventriculitis.
World neurosurgery, 2018Co-Authors: Anna Nilsson, Erik Uvelius, David Cederberg, Erik KronvallAbstract:Ventriculitis is a serious complication when using external ventricular drains (EVDs). Bactericidal silver coating has been reported to reduce risk of infection. In the clinical setting, the diagnosis is often made based on symptoms and analyses of cerebrospinal fluid, with treatment initiated before infection is verified by culture. The bactericidal effect might not correlate with a reduced rate of clinically diagnosed infections. This retrospective study aimed to analyze if use of silver-coated EVDs is associated with a reduced rate of Ventriculitis. During 1 year, clinical routine was changed from inserting noncoated catheters to silver-coated catheters. Rate of Ventriculitis was compared between patient groups based on catheter type. To examine the clinical impact of silver coating, Ventriculitis was defined as cases where antibiotic treatment was initiated on clinical suspicion. Among 296 patients (186 noncoated and 110 silver-coated catheters), 18.9% were treated for Ventriculitis, with 21.0% in the noncoated group and 15.5% in the silver-coated group (P = 0.242). Silver coating did not reduce the rate of positive cultures. Duration of EVD treatment was the single significant risk factor for Ventriculitis. Silver-coated catheters did not reduce the need for cerebrospinal fluid shunt placement, days with antibiotics, days with EVD, or days in the intensive care unit. The previously reported bactericidal effect of silver-coated EVDs did not alter the clinical course to significantly reduce the number of treated cases of Ventriculitis. The introduction of silver-coated EVDs cannot be motivated by reduced use of antibiotics or shorter hospital stay. Copyright © 2018 Elsevier Inc. All rights reserved.
David K. Warren - One of the best experts on this subject based on the ideXlab platform.
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Comparing External Ventricular Drains-Related Ventriculitis Surveillance Definitions.
Infection control and hospital epidemiology, 2017Co-Authors: Maria M Reyes, Gregory J Zipfel, Satish Munigala, Emily L Church, Tobias Kulik, Salah Keyrouz, David K. WarrenAbstract:OBJECTIVE To evaluate the agreement between the current National Healthcare Safety Network (NHSN) definition for Ventriculitis and others found in the literature among patients with an external ventricular drain (EVD) DESIGN Retrospective cohort study from January 2009 to December 2014 SETTING Neurology and neurosurgery intensive care unit of a large tertiary-care center PATIENTS Patients with an EVD were included. Patients with an infection prior to EVD placement or a permanent ventricular shunt were excluded. METHODS We reviewed the charts of patients with positive cerebrospinal fluid (CSF) cultures and/or abnormal CSF results while they had an EVD in place and applied various Ventriculitis definitions. RESULTS We identified 48 patients with a total of 52 cases of Ventriculitis (41 CSF culture-positive cases and 11 cases based on abnormal CSF test results) using the NHSN definition. The most common organisms causing Ventriculitis were gram-positive commensals (79.2%); however, 45% showed growth of only 1 colony on 1 piece of media. Approximately 60% of the Ventriculitis cases by the NHSN definition met the Honda criteria, approximately 56% met the Gozal criteria, and 23% met Citerio's definition. Cases defined using Honda versus Gozal definitions had a moderate agreement (κ=0.528; P
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comparing external ventricular drains related Ventriculitis surveillance definitions
Infection Control and Hospital Epidemiology, 2017Co-Authors: Maria Reyes, Gregory J Zipfel, Satish Munigala, Emily L Church, Tobias Kulik, Salah Keyrouz, David K. WarrenAbstract:OBJECTIVE To evaluate the agreement between the current National Healthcare Safety Network (NHSN) definition for Ventriculitis and others found in the literature among patients with an external ventricular drain (EVD) DESIGN Retrospective cohort study from January 2009 to December 2014 SETTING Neurology and neurosurgery intensive care unit of a large tertiary-care center PATIENTS Patients with an EVD were included. Patients with an infection prior to EVD placement or a permanent ventricular shunt were excluded. METHODS We reviewed the charts of patients with positive cerebrospinal fluid (CSF) cultures and/or abnormal CSF results while they had an EVD in place and applied various Ventriculitis definitions. RESULTS We identified 48 patients with a total of 52 cases of Ventriculitis (41 CSF culture-positive cases and 11 cases based on abnormal CSF test results) using the NHSN definition. The most common organisms causing Ventriculitis were gram-positive commensals (79.2%); however, 45% showed growth of only 1 colony on 1 piece of media. Approximately 60% of the Ventriculitis cases by the NHSN definition met the Honda criteria, approximately 56% met the Gozal criteria, and 23% met Citerio's definition. Cases defined using Honda versus Gozal definitions had a moderate agreement (κ=0.528; P<.05) whereas comparisons of Honda versus Citerio definitions (κ=0.338; P<.05) and Citerio versus Gozal definitions (κ=0.384; P<.05) had only fair agreements. CONCLUSIONS The agreement between published ventriculostomy-associated infection (VAI) definitions in this cohort was moderate to fair. A VAI surveillance definition that better defines contaminants is needed for more homogenous application of surveillance definitions between institutions and better comparison of rates. Infect Control Hosp Epidemiol 2017;38:574-579.
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reducing the incidence of intraventricular catheter related Ventriculitis in the neurology neurosurgical intensive care unit at a tertiary care center in st louis missouri an 8 year follow up study
Infection Control and Hospital Epidemiology, 2010Co-Authors: Hitoshi Honda, Martha Craighead, Jeffrey C Jones, Michael N Diringer, Ralph G Dacey, David K. WarrenAbstract:We reviewed the effect of 3 interventions to reduce the incidence of intraventricular catheter-related Ventriculitis, conducted at a tertiary care center in St Louis, Missouri, during an 8-year period. The incidence density of intraventricular catheter-related Ventriculitis decreased substantially after the implementation of standardized management of intraventricular catheters.
Anna Nilsson - One of the best experts on this subject based on the ideXlab platform.
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Silver-Coated Ventriculostomy Catheters Do Not Reduce Rates of Clinically Diagnosed Ventriculitis.
World Neurosurgery, 2018Co-Authors: Anna Nilsson, Erik Uvelius, David Cederberg, Erik KronvallAbstract:Background Ventriculitis is a serious complication when using external ventricular drains (EVDs). Bactericidal silver coating has been reported to reduce risk of infection. In the clinical setting, the diagnosis is often made based on symptoms and analyses of cerebrospinal fluid, with treatment initiated before infection is verified by culture. The bactericidal effect might not correlate with a reduced rate of clinically diagnosed infections. This retrospective study aimed to analyze if use of silver-coated EVDs is associated with a reduced rate of Ventriculitis. Methods During 1 year, clinical routine was changed from inserting noncoated catheters to silver-coated catheters. Rate of Ventriculitis was compared between patient groups based on catheter type. To examine the clinical impact of silver coating, Ventriculitis was defined as cases where antibiotic treatment was initiated on clinical suspicion. Results Among 296 patients (186 noncoated and 110 silver-coated catheters), 18.9% were treated for Ventriculitis, with 21.0% in the noncoated group and 15.5% in the silver-coated group (P = 0.242). Silver coating did not reduce the rate of positive cultures. Duration of EVD treatment was the single significant risk factor for Ventriculitis. Silver-coated catheters did not reduce the need for cerebrospinal fluid shunt placement, days with antibiotics, days with EVD, or days in the intensive care unit. Conclusions The previously reported bactericidal effect of silver-coated EVDs did not alter the clinical course to significantly reduce the number of treated cases of Ventriculitis. The introduction of silver-coated EVDs cannot be motivated by reduced use of antibiotics or shorter hospital stay.
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Silver-Coated Ventriculostomy Catheters Do Not Reduce Rates of Clinically Diagnosed Ventriculitis.
World neurosurgery, 2018Co-Authors: Anna Nilsson, Erik Uvelius, David Cederberg, Erik KronvallAbstract:Ventriculitis is a serious complication when using external ventricular drains (EVDs). Bactericidal silver coating has been reported to reduce risk of infection. In the clinical setting, the diagnosis is often made based on symptoms and analyses of cerebrospinal fluid, with treatment initiated before infection is verified by culture. The bactericidal effect might not correlate with a reduced rate of clinically diagnosed infections. This retrospective study aimed to analyze if use of silver-coated EVDs is associated with a reduced rate of Ventriculitis. During 1 year, clinical routine was changed from inserting noncoated catheters to silver-coated catheters. Rate of Ventriculitis was compared between patient groups based on catheter type. To examine the clinical impact of silver coating, Ventriculitis was defined as cases where antibiotic treatment was initiated on clinical suspicion. Among 296 patients (186 noncoated and 110 silver-coated catheters), 18.9% were treated for Ventriculitis, with 21.0% in the noncoated group and 15.5% in the silver-coated group (P = 0.242). Silver coating did not reduce the rate of positive cultures. Duration of EVD treatment was the single significant risk factor for Ventriculitis. Silver-coated catheters did not reduce the need for cerebrospinal fluid shunt placement, days with antibiotics, days with EVD, or days in the intensive care unit. The previously reported bactericidal effect of silver-coated EVDs did not alter the clinical course to significantly reduce the number of treated cases of Ventriculitis. The introduction of silver-coated EVDs cannot be motivated by reduced use of antibiotics or shorter hospital stay. Copyright © 2018 Elsevier Inc. All rights reserved.
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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Cerebrospinal fluid penetration of meropenem in neurocritical care patients with proven or suspected Ventriculitis: a prospective observational study
Critical care (London England), 2016Co-Authors: Ute Blassmann, J Briegel, Niklas Thon, William W. Hope, Anka C. Roehr, Otto R. Frey, Cornelia Vetter-kerkhoff, Volker HugeAbstract:Background Ventriculitis is a complication of temporary intraventricular drains. The limited penetration of meropenem into the cerebrospinal fluid (CSF) is well known. However, ventricular CSF pharmacokinetic data in patients with Ventriculitis are lacking. The aim of this study was to evaluate meropenem pharmacokinetics in the serum and CSF of neurocritical care patients with proven or suspected Ventriculitis.
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cerebrospinal fluid penetration of meropenem in neurocritical care patients with proven or suspected Ventriculitis a prospective observational study
Critical Care, 2016Co-Authors: Ute Blassmann, J Briegel, Niklas Thon, William W. Hope, Anka C. Roehr, Otto R. Frey, Cornelia Vetterkerkhoff, Volker HugeAbstract:Ventriculitis is a complication of temporary intraventricular drains. The limited penetration of meropenem into the cerebrospinal fluid (CSF) is well known. However, ventricular CSF pharmacokinetic data in patients with Ventriculitis are lacking. The aim of this study was to evaluate meropenem pharmacokinetics in the serum and CSF of neurocritical care patients with proven or suspected Ventriculitis. We conducted an observational pharmacokinetic study of neurocritical care patients with proven or suspected Ventriculitis receiving meropenem. Multiple blood and CSF samples were taken and were described using nonparametric pharmacokinetic modelling with Pmetrics. In total, 21 patients (median age 52 years, median weight 76 kg) were included. The median (range) of peak and trough concentrations in serum were 20.16 (4.40–69.00) mg/L and 2.54 (0.00–31.40) mg/L, respectively. The corresponding peak and trough concentrations in CSF were 1.20 (0.00–6.20) mg/L and 1.28 (0.00–4.10) mg/L, respectively, with a median CSF/serum ratio (range) of 0.09 (0.03–0.16). Median creatinine clearance ranged from 60.7 to 217.6 ml/minute (median 122.5 ml/minute). A three-compartment linear population pharmacokinetic model was most appropriate. No covariate relationships could be supported for any of the model parameters. Meropenem demonstrated poor penetration into CSF, with a median CSF/serum ratio of 9 % and high interindividual pharmacokinetic variability. Administration of higher-than-standard doses of meropenem and therapeutic drug monitoring in both serum and CSF should be considered to individualise meropenem dosing in neurocritical care patients with Ventriculitis.
David Cederberg - One of the best experts on this subject based on the ideXlab platform.
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Silver-Coated Ventriculostomy Catheters Do Not Reduce Rates of Clinically Diagnosed Ventriculitis.
World Neurosurgery, 2018Co-Authors: Anna Nilsson, Erik Uvelius, David Cederberg, Erik KronvallAbstract:Background Ventriculitis is a serious complication when using external ventricular drains (EVDs). Bactericidal silver coating has been reported to reduce risk of infection. In the clinical setting, the diagnosis is often made based on symptoms and analyses of cerebrospinal fluid, with treatment initiated before infection is verified by culture. The bactericidal effect might not correlate with a reduced rate of clinically diagnosed infections. This retrospective study aimed to analyze if use of silver-coated EVDs is associated with a reduced rate of Ventriculitis. Methods During 1 year, clinical routine was changed from inserting noncoated catheters to silver-coated catheters. Rate of Ventriculitis was compared between patient groups based on catheter type. To examine the clinical impact of silver coating, Ventriculitis was defined as cases where antibiotic treatment was initiated on clinical suspicion. Results Among 296 patients (186 noncoated and 110 silver-coated catheters), 18.9% were treated for Ventriculitis, with 21.0% in the noncoated group and 15.5% in the silver-coated group (P = 0.242). Silver coating did not reduce the rate of positive cultures. Duration of EVD treatment was the single significant risk factor for Ventriculitis. Silver-coated catheters did not reduce the need for cerebrospinal fluid shunt placement, days with antibiotics, days with EVD, or days in the intensive care unit. Conclusions The previously reported bactericidal effect of silver-coated EVDs did not alter the clinical course to significantly reduce the number of treated cases of Ventriculitis. The introduction of silver-coated EVDs cannot be motivated by reduced use of antibiotics or shorter hospital stay.
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Silver-Coated Ventriculostomy Catheters Do Not Reduce Rates of Clinically Diagnosed Ventriculitis.
World neurosurgery, 2018Co-Authors: Anna Nilsson, Erik Uvelius, David Cederberg, Erik KronvallAbstract:Ventriculitis is a serious complication when using external ventricular drains (EVDs). Bactericidal silver coating has been reported to reduce risk of infection. In the clinical setting, the diagnosis is often made based on symptoms and analyses of cerebrospinal fluid, with treatment initiated before infection is verified by culture. The bactericidal effect might not correlate with a reduced rate of clinically diagnosed infections. This retrospective study aimed to analyze if use of silver-coated EVDs is associated with a reduced rate of Ventriculitis. During 1 year, clinical routine was changed from inserting noncoated catheters to silver-coated catheters. Rate of Ventriculitis was compared between patient groups based on catheter type. To examine the clinical impact of silver coating, Ventriculitis was defined as cases where antibiotic treatment was initiated on clinical suspicion. Among 296 patients (186 noncoated and 110 silver-coated catheters), 18.9% were treated for Ventriculitis, with 21.0% in the noncoated group and 15.5% in the silver-coated group (P = 0.242). Silver coating did not reduce the rate of positive cultures. Duration of EVD treatment was the single significant risk factor for Ventriculitis. Silver-coated catheters did not reduce the need for cerebrospinal fluid shunt placement, days with antibiotics, days with EVD, or days in the intensive care unit. The previously reported bactericidal effect of silver-coated EVDs did not alter the clinical course to significantly reduce the number of treated cases of Ventriculitis. The introduction of silver-coated EVDs cannot be motivated by reduced use of antibiotics or shorter hospital stay. Copyright © 2018 Elsevier Inc. All rights reserved.
