title: Ventriculostomy-associated infection: a new, standardized reporting definition and institutional experience.
abstract: OBJECTIVE
  Shortcomings created by the lack of both a uniform definition of ventriculostomy-associated infection (VAI) and reporting standards have led to widely ranging infections rates (2-24%) whose significance is uncertain. We propose a standardized definition of VAI and a consistent reporting format compliant with Centers for Disease Control and Prevention (CDC) for device-related infections. Using those parameters to establish an infection-control surveillance program, we report our 4-year institutional VAI rates.
  
  
  METHODS
  In this prospective study covering ventriculostomy utilization (October 2006-December 2010), 498 patients had a total of 4,673 ventriculostomy days. By review of the literature and our institutional analysis, we defined VAI as a positive CSF culture in a patient with ventriculostomy catheter, plus one or more of the following (1) fever recorded >101.5 °F or (2) cerebrospinal fluid (CSF) glucose level, either <50 mg/dL or <50% of a serum glucose level drawn within 24 h of the CSF glucose. In a report format that is CDC compliant, rates of VAI are reported.
  
  
  RESULTS
  Among our patients, the CDC-compliant infection rate was 2.14 per 1,000 ventriculostomy days. Of the 10 VAIs occurring in 498 patients during 4,673 ventriculostomy days, this 2.0% infection rate was lower than the previously reported 8.8% composite rates of VAI. Average duration of ventriculostomy was 9.4 days. Neither antibiotic-impregnated catheters nor periprocedural or prophylactic antibiotics were used.
  
  
  CONCLUSIONS
  Our standardized VAI definition and CDC format seems promising toward facilitating future study and guideline development. Given our strict protocol of sterile catheter placement and care, and our institution's low 2.0% infection rates, we propose an infection-rate target of ≤5 per 1,000 device days. Our results suggest that the use of antibiotics or antibiotic-impregnated catheters is unwarranted--a positive given concerns of evolving anti-microbial resistance.
authors.affiliation: Department of Neurosurgery, University of Cincinnati College of Medicine, ML 0515, Cincinnati, OH, 45267-0515, USA.
authors.forename: Yair M
authors.initials: YM
authors.lastname: Gozal
authors.forename: Chad W
authors.initials: CW
authors.lastname: Farley
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Hanseman
authors.forename: Daniel
authors.initials: D
authors.lastname: Harwell
authors.forename: Mark
authors.initials: M
authors.lastname: Magner
authors.forename: Norberto
authors.initials: N
authors.lastname: Andaluz
authors.forename: Lori
authors.initials: L
authors.lastname: Shutter
mesh_terms: D000328:Adult; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000382:microbiology / Q000706:statistics & numerical data; D003422:Critical Care / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards*; D013530:Surgical Wound Infection / Q000134:cerebrospinal fluid / Q000382:microbiology / Q000503:physiopathology; D014696:Ventriculostomy / Q000009:adverse effects* / Q000706:statistics & numerical data