title: Characteristics of infections associated with external ventricular drains of cerebrospinal fluid.
abstract: OBJECTIVE
  Manifestations of external ventricular drain (EVD) - associated infections overlap with those of the underlying neurosurgical conditions. We analyzed characteristics of EVD-associated infections.
  
  
  METHODS
  We included patients aged ≥18 years with EVD-associated infections from 1997 to 2008, using modified CDC criteria for nosocomial infections. Hospital charts were reviewed retrospectively and the in-hospital outcome was evaluated.
  
  
  RESULTS
  Forty-eight patients with EVD-associated infections were included (median age, 52 years, range 20-74 years). The median EVD-indwelling time was 7 days (range, 1-39 days) and EVD-associated infection occurred 6 days after insertion (range, 1-17 days). In 23% of patients, meningitis occurred 1-10 days after EVD removal. Fever >38 °C was present in 79% of patients, but Glasgow Coma Scale (GCS) scores were reduced in only 29%, and headache, vomiting and/or neck stiffness were present in only 31%. The median cerebrospinal fluid (CSF) leukocyte count was higher at onset of EVD-associated infection than at EVD insertion (175 × 10(6)/l versus 46 × 10(6)/l, p = 0.021), but other CSF parameters did not differ significantly. The most commonly implicated organisms were coagulase-negative staphylococci (63%) and Propionibacterium acnes (15%).
  
  
  CONCLUSIONS
  Fever and increased CSF leukocytes should raise the suspicion of EVD-associated infection, which may occur up to 10 days after removal of EVD.
authors: Septic Surgery Unit, Department of Surgery and Anesthesiology, University Hospital Lausanne, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland.
authors: Laura N
authors: LN
authors: Walti
authors: Anna
authors: A
authors: Conen
authors: Julia
authors: J
authors: Coward
authors: Gregory F
authors: GF
authors: Jost
authors: Andrej
authors: A
authors: Trampuz
mesh_terms: D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis; D055499:Catheter-Related Infections / Q000134:cerebrospinal fluid / Q000382:microbiology*; D002408:Catheters, Indwelling / Q000382:microbiology*; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D005947:Glucose / Q000134:cerebrospinal fluid; D006801:Humans; D019344:Lactic Acid / Q000134:cerebrospinal fluid; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D019344:Lactic Acid; D002097:C-Reactive Protein; D005947:Glucose