TY - JOUR

T1 - Diagnostic criteria of CNS infection in patients with external ventricular drainage after traumatic brain injury

T2 - a pilot study

AU - Willer-Hansen, Rasmus Stanley

AU - Olsen, Markus Harboe

AU - Hauerberg, John

AU - Johansen, Helle Krogh

AU - Andersen, Åse Bengaard

AU - Møller, Kirsten

N1 - Publisher Copyright: © 2022 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

PY - 2022

Y1 - 2022

N2 - Background: Ventriculostomy-related infection (VRI) is a common complication in patients with traumatic brain injury (TBI) treated with an external ventricular drain (EVD). The aim of this study was to investigate incidence and characteristics of patients with VRI, and to explore diagnostic criteria to confidently rule out VRI in patients with TBI. Methods: This retrospective cohort pilot study included adults with severe TBI who were admitted to the ICU and received an EVD, during a 26-month period. Patients were categorized as having Culture-positive VRI, Culture-negative VRI, or No VRI. Variables that were potentially associated with Culture-positive VRI was analyzed, and predictive values were calculated. Results: 75 of 215 patients with severe TBI (35%) underwent EVD placement; nine of these (12%) were classified as Culture-negative VRI and eight (11%) as Culture-positive VRI. The CSF cell counts that led to VRI treatment were compared with 46 CSF cell counts from No VRI patients. A CSF/plasma glucose ratio below 0.6 had a negative predictive value (NPV) for culture-verified VRI of 0.97 (95% CI: 0.85–1), whereas a combination of three CSF-derived biomarkers within the reference limits (white/red blood cell ratio, CSF/plasma glucose ratio, and protein content) ruled out Culture-positive VRI in this cohort (PPV 0, 95% CI: 0–0.14). C-reactive protein did not reliably predict VRI. Conclusions: In this pilot study of patients after severe, a combination of biomarkers within reference limits ruled out VRI (PPV 0, CI: 0–0.14). Hypoglycorrhachia was a sensitive marker of VRI (NPV 0.97, CI: 0.85–1). Systemic signs and markers of infection did not predict VRI.

AB - Background: Ventriculostomy-related infection (VRI) is a common complication in patients with traumatic brain injury (TBI) treated with an external ventricular drain (EVD). The aim of this study was to investigate incidence and characteristics of patients with VRI, and to explore diagnostic criteria to confidently rule out VRI in patients with TBI. Methods: This retrospective cohort pilot study included adults with severe TBI who were admitted to the ICU and received an EVD, during a 26-month period. Patients were categorized as having Culture-positive VRI, Culture-negative VRI, or No VRI. Variables that were potentially associated with Culture-positive VRI was analyzed, and predictive values were calculated. Results: 75 of 215 patients with severe TBI (35%) underwent EVD placement; nine of these (12%) were classified as Culture-negative VRI and eight (11%) as Culture-positive VRI. The CSF cell counts that led to VRI treatment were compared with 46 CSF cell counts from No VRI patients. A CSF/plasma glucose ratio below 0.6 had a negative predictive value (NPV) for culture-verified VRI of 0.97 (95% CI: 0.85–1), whereas a combination of three CSF-derived biomarkers within the reference limits (white/red blood cell ratio, CSF/plasma glucose ratio, and protein content) ruled out Culture-positive VRI in this cohort (PPV 0, 95% CI: 0–0.14). C-reactive protein did not reliably predict VRI. Conclusions: In this pilot study of patients after severe, a combination of biomarkers within reference limits ruled out VRI (PPV 0, CI: 0–0.14). Hypoglycorrhachia was a sensitive marker of VRI (NPV 0.97, CI: 0.85–1). Systemic signs and markers of infection did not predict VRI.

KW - central nervous system infections

KW - cerebrospinal fluid drains

KW - cerebrospinal fluid shunts

KW - external ventricular drainage

KW - meningitis

KW - traumatic brain injury

KW - ventriculitis

U2 - 10.1111/aas.14036

DO - 10.1111/aas.14036

M3 - Journal article

C2 - 35118661

AN - SCOPUS:85124565000

VL - 66

SP - 507

EP - 515

JO - Acta Anaesthesiologica Scandinavica

JF - Acta Anaesthesiologica Scandinavica

SN - 0001-5172

IS - 4

ER -