Ventriculostomy-related infections: a critical review of the literature.
OBJECTIVE
To provide a critical evaluation of the published literature describing risk factors for ventriculostomy-related infections (VRIs) and the efficacy of prophylactic catheter exchange.


METHODS
A MEDLINE literature search was performed, and data were extracted from studies published from 1941 through 2001.


RESULTS
Published criteria for diagnosing VRIs are highly variable. Intraventricular hemorrhage, subarachnoid hemorrhage, cranial fracture with cerebrospinal fluid leak, craniotomy, systemic infections, and catheter irrigation all predispose patients to the development of VRIs. Extended duration of catheterization is correlated with an increasing risk of cerebrospinal fluid infections during the first 10 days of catheterization. Prophylactic catheter exchange does not modify the risk of developing later VRIs in retrospective studies.


CONCLUSIONS
Categorizing suspected cerebrospinal fluid infections as contaminants, colonization, suspected or confirmed VRIs, or ventriculitis more accurately describes the patient's clinical condition and may indicate different management strategies. A prospective, randomized clinical trial is required to further evaluate the efficacy of prophylactic catheter exchange in limiting the incidence of VRIs during prolonged catheterization. Although prophylactic catheter exchange remains a practice option, the available data suggest that this procedure is not currently justified.
Lozier
Alan P
AP
Department of Neurosurgery, The Neurological Institute of New York, College of Physicians and Surgeons, Columbia University, New York 10032-3784, USA. AL466@columbia.edu
Sciacca
Robert R
RR
Romagnoli
Mario F
MF
Connolly
E Sander
ES
D002408:Catheters, Indwelling / Q000009:adverse effects*; D002555:Cerebrospinal Fluid / Q000382:microbiology; D003428:Cross Infection / Q000209:etiology*; D004866:Equipment Contamination; D006801:Humans; D016920:Meningitis, Bacterial / Q000209:etiology*; D011183:Postoperative Complications / Q000209:etiology*; D012086:Reoperation; D012307:Risk Factors; D014696:Ventriculostomy / Q000295:instrumentation*