Serum procalcitonin in cerebral ventriculitis.
OBJECTIVE
The objective of this study was to test the hypothesis that serum procalcitonin is increased in patients with bacterial cerebral ventricular infections after the insertion of temporary external ventricular drains.


METHODS
This open, prospective study included patients requiring temporary external ventricular drains for various neurologic conditions such as intracerebral hemorrhage with ventricular hemorrhage or space-occupying lesions in the posterior fossa (cerebellar infarctions or hemorrhages). Patients experiencing primary central nervous system infection or sepsis were excluded. Procalcitonin, C-reactive protein, and white blood cell count were measured daily. Cerebrospinal fluid was investigated every other day, including cerebrospinal fluid cell count, lactate, glucose, and cerebrospinal fluid culture. Results were categorized according to presence of bacterial cerebrospinal fluid infection as determined by positive cerebrospinal fluid cultures.


RESULTS
A total of 34 consecutive patients were included. Procalcitonin was significantly higher (4.7 vs. 0.2 ng/mL) in patients with proven bacterial ventriculitis. Cerebrospinal fluid cell count (456 vs. 478 cells/microL) could not distinguish bacterial infection from abacterial reactions, mainly because of blood contamination of the cerebrospinal fluid.


CONCLUSIONS
Cerebrospinal fluid of patients treated with temporary external ventricular drains is frequently characterized by blood contamination because of the insertion procedure, the underlying neurologic disorder such as ventricular hemorrhage, or the presence of an abacterial chemical ventriculitis. Thus, diagnosis of a bacterial ventricular infection requiring immediate antibiotic therapy is less certain. Serum procalcitonin adds to the diagnostic precision in bacterial ventriculitis.
Berger
Christian
C
Department of Neurology and Neurosurgery, University of Heidelberg, Germany.
Schwarz
Stefan
S
Schaebitz
Wolf R
WR
Aschoff
Alfred
A
Schwab
Stefan
S
D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D002552:Cerebral Ventricles / Q000098:blood supply* / Q000382:microbiology*; D004660:Encephalitis / Q000097:blood* / Q000134:cerebrospinal fluid / Q000175:diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D012680:Sensitivity and Specificity; D013203:Staphylococcal Infections / Q000097:blood / Q000175:diagnosis / Q000382:microbiology; D013290:Streptococcal Infections / Q000097:blood / Q000175:diagnosis / Q000382:microbiology
D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide