Ventriculostomy-related infections. A prospective epidemiologic study.
We concluded a prospective epidemiologic study of ventriculostomy-related infections (ventriculitis or meningitis) in 172 consecutive neurosurgical patients over a two-year period to determine the incidence, risk factors, and clinical characteristics of the infections. Ventriculitis or meningitis developed in 19 of 172 patients (11 per cent) undergoing a total of 213 ventriculostomies. When data from all these cases plus five cases of nonventriculostomy-related infection were combined, cerebrospinal-fluid pleocytosis was more significantly associated with the diagnosis of ventriculitis or meningitis (P less than 0.0001) than were fever and leukocytosis (P = 0.07). Risk factors for ventriculostomy-related infections included intracerebral hemorrhage with intraventricular hemorrhage (P = 0.027), neurosurgical operations (P = 0.016), intracranial pressure of 20 mm Hg or more (P = 0.019), ventricular catheterization for more than five days (P = 0.017), and irrigation of the system (P = 0.021). Previous ventriculostomy did not increase the risk of infection with subsequent procedures. We conclude that ventriculostomy-related infections may be prevented by maintenance of a closed drainage system and by early removal of the ventricular catheter. If monitoring is required for more than five days, the catheter should be removed and inserted at a different site.
D001419:Bacteria / Q000302:isolation & purification; D002404:Catheterization / Q000009:adverse effects* / Q000379:methods; D002543:Cerebral Hemorrhage / Q000150:complications; D002552:Cerebral Ventricles / Q000601:surgery*; D004660:Encephalitis / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology; D004812:Epidemiologic Methods; D005334:Fever / Q000150:complications; D006801:Humans; D007239:Infections / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology; D007427:Intracranial Pressure; D007964:Leukocytosis / Q000150:complications; D008581:Meningitis / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology; D008991:Monitoring, Physiologic / Q000009:adverse effects; D011183:Postoperative Complications; D011446:Prospective Studies; D012306:Risk; D013997:Time Factors