title: Predictors of extraventricular drain-associated bacterial ventriculitis.
abstract: OBJECTIVE
  Bacterial ventriculitis (BV) may develop in patients requiring external ventricular drains (EVDs). The purpose of this study was to determine predictors of EVD-associated BV onset.
  
  
  METHODS
  A retrospective review of Duke University Hospital patients with EVD device placement between January 2005 and May 2010 was conducted. Subject data were captured for predefined variables. Outcomes included in-hospital mortality, length of stay, and neurologic status at discharge.
  
  
  RESULTS
  In 410 subjects with 420 EVDs, the BV rate was 10.2%. Univariate analysis indicated that age, sex, positive blood culture, duration of EVD placement, and the number of cerebrospinal fluid (CSF) samples taken were associated with BV. Of these, the number of CSF samples and sex retained significance in multivariable modeling (female: odds ratio, 0.47 [confidence interval, 0.23-0.97]; CSF samples: odds ratio, 1.08 [confidence interval 1.01-1.17]; P = .04; c index = 0.69). In this model, each CSF sample taken expanded the likelihood of BV by 8.3%. The most common pathogens were Staphylococcus or proprioniobacter (n = 26). Bacterial ventriculitis was associated with an increase in hospital length of stay (33 ± 22.9 days vs 24.6 ± 20.4 days; P = .04) but not mortality.
  
  
  CONCLUSIONS
  An association exists between CSF sampling frequency and the development of EVD-associated BV. Larger prospective studies should be aimed at identifying causal relationships between these variables.
authors.affiliation: Brain Injury Translational Research Center, Duke University, DUMC 2900, Durham, NC; Department of Anesthesiology, Duke University, DUMC 3094, Durham, NC.
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Williamson
authors.affiliation: Department of Anesthesiology, Duke University, DUMC 3094, Durham, NC.
authors.forename: Barbara G
authors.initials: BG
authors.lastname: Phillips-Bute
authors.affiliation: Department of Anesthesiology, Duke University, DUMC 3094, Durham, NC; Department of Medicine (Neurology), Duke University, DUMC 2900, Durham, NC.
authors.forename: David L
authors.initials: DL
authors.lastname: McDonagh
authors.affiliation: Brain Injury Translational Research Center, Duke University, DUMC 2900, Durham, NC; Department of Anesthesiology, Duke University, DUMC 3094, Durham, NC.
authors.forename: Marisa C
authors.initials: MC
authors.lastname: Gray
authors.affiliation: Department of Surgery (Neurosurgery), Duke University, DUMC 3087, Durham, NC.
authors.forename: Ali R
authors.initials: AR
authors.lastname: Zomorodi
authors.affiliation: Department of Medicine (Neurology), Duke University, DUMC 2900, Durham, NC; School of Nursing, Duke University, DUMC 3322, Durham, NC.
authors.forename: Daiwai M
authors.initials: DM
authors.lastname: Olson
authors.affiliation: Department of Surgery (Neurosurgery), Duke University, DUMC 3087, Durham, NC.
authors.forename: Gavin W
authors.initials: GW
authors.lastname: Britz
authors.affiliation: Brain Injury Translational Research Center, Duke University, DUMC 2900, Durham, NC; Department of Anesthesiology, Duke University, DUMC 3094, Durham, NC; Department of Medicine (Neurology), Duke University, DUMC 2900, Durham, NC.
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Laskowitz
authors.affiliation: Brain Injury Translational Research Center, Duke University, DUMC 2900, Durham, NC; Department of Anesthesiology, Duke University, DUMC 3094, Durham, NC; Department of Medicine (Neurology), Duke University, DUMC 2900, Durham, NC. Electronic address: michael.james@duke.edu.
authors.forename: Michael L
authors.initials: ML
authors.lastname: James
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001424:Bacterial Infections / Q000209:etiology* / Q000382:microbiology; D058565:Cerebral Ventriculitis / Q000209:etiology* / Q000382:microbiology; D002555:Cerebrospinal Fluid; D003422:Critical Care / Q000706:statistics & numerical data*; D004322:Drainage / Q000009:adverse effects*; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012737:Sex Factors
keywords: CSF; Clinical neurology; Extraventricular drain; Intensive care; Neurosurgery; Ventriculitis