Ventriculostomy-associated infection (VAI) in patients with acute brain injury—a retrospective study
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Ventriculostomy-associated infection (VAI) in patients with acute brain injury—a retrospective study. / Nielsen, Pernille; Olsen, Markus Harboe; Willer-Hansen, Rasmus Stanley; Hauerberg, John; Johansen, Helle Krogh; Andersen, Aase Bengaard; Knudsen, Jenny Dahl; Møller, Kirsten.
In: Acta Neurochirurgica, Vol. 166, No. 1, 128, 2024.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Ventriculostomy-associated infection (VAI) in patients with acute brain injury—a retrospective study
AU - Nielsen, Pernille
AU - Olsen, Markus Harboe
AU - Willer-Hansen, Rasmus Stanley
AU - Hauerberg, John
AU - Johansen, Helle Krogh
AU - Andersen, Aase Bengaard
AU - Knudsen, Jenny Dahl
AU - Møller, Kirsten
N1 - Publisher Copyright: © The Author(s) 2024.
PY - 2024
Y1 - 2024
N2 - Background: Ventriculostomy-associated infection (VAI) is common after external ventricular drains (EVD) insertion but is difficult to diagnose in patients with acute brain injury. Previously, we proposed a set of criteria for ruling out VAI in traumatic brain injury. This study aimed to validate these criteria. For exploratory purposes, we sought to develop and validate a score for VAI risk assessment in patients with different types of severe acute brain injury. Methods: This retrospective cohort study included adults with acute brain injury who received an EVD and in whom CSF samples were taken over a period of 57 months. As standard non-coated bolt-connected EVDs were used. The predictive performance of biomarkers was analyzed as defined previously. A multivariable regression model was performed with five variables. Results: A total of 683 patients with acute brain injury underwent EVD placement and had 1272 CSF samples; 92 (13.5%) patients were categorized as culture-positive VAI, 130 (19%) as culture-negative VAI, and 461 (67.5%) as no VAI. A low CSF WBC/RBC ratio (< 0.037), high CSF/plasma glucose ratio (> 0.6), and low CSF protein (< 0.5g/L) showed a positive predictive value of 0.09 (95%CI, 0.05–0.13). In the multivariable logistic regression model, days to sample (OR 1.09; 95%CI, 1.03–1.16) and CSF WBC/RBC ratio (OR 34.86; 95%CI, 3.94–683.15) were found to predict VAI. Conclusion: In patients with acute brain injury and an EVD, our proposed combined cut-off for ruling out VAI performed satisfactorily. Days to sample and CSF WBC/RBC ratio were found independent predictors for VAI in the multivariable logistic regression model.
AB - Background: Ventriculostomy-associated infection (VAI) is common after external ventricular drains (EVD) insertion but is difficult to diagnose in patients with acute brain injury. Previously, we proposed a set of criteria for ruling out VAI in traumatic brain injury. This study aimed to validate these criteria. For exploratory purposes, we sought to develop and validate a score for VAI risk assessment in patients with different types of severe acute brain injury. Methods: This retrospective cohort study included adults with acute brain injury who received an EVD and in whom CSF samples were taken over a period of 57 months. As standard non-coated bolt-connected EVDs were used. The predictive performance of biomarkers was analyzed as defined previously. A multivariable regression model was performed with five variables. Results: A total of 683 patients with acute brain injury underwent EVD placement and had 1272 CSF samples; 92 (13.5%) patients were categorized as culture-positive VAI, 130 (19%) as culture-negative VAI, and 461 (67.5%) as no VAI. A low CSF WBC/RBC ratio (< 0.037), high CSF/plasma glucose ratio (> 0.6), and low CSF protein (< 0.5g/L) showed a positive predictive value of 0.09 (95%CI, 0.05–0.13). In the multivariable logistic regression model, days to sample (OR 1.09; 95%CI, 1.03–1.16) and CSF WBC/RBC ratio (OR 34.86; 95%CI, 3.94–683.15) were found to predict VAI. Conclusion: In patients with acute brain injury and an EVD, our proposed combined cut-off for ruling out VAI performed satisfactorily. Days to sample and CSF WBC/RBC ratio were found independent predictors for VAI in the multivariable logistic regression model.
KW - Acute brain injury
KW - Bacterial infections and mycoses
KW - Brain injuries
KW - Catheter-related infections
KW - Central nervous system infections
KW - Cerebrospinal fluid shunts
KW - Cerebrovascular disorders
KW - Drainage
KW - EVD infections
KW - Infections
KW - Postoperative complications
KW - Ventriculostomy
KW - Ventriculostomy associated infections
U2 - 10.1007/s00701-024-06018-w
DO - 10.1007/s00701-024-06018-w
M3 - Journal article
C2 - 38462573
AN - SCOPUS:85187440142
VL - 166
JO - Acta Neurochirurgica
JF - Acta Neurochirurgica
SN - 0001-6268
IS - 1
M1 - 128
ER -
ID: 385583808