title: Post craniotomy extra-ventricular drain (EVD) associated nosocomial meningitis: CSF diagnostic criteria.
abstract: Because external ventricular drains (EVDs) provide access to cerebrospinal fluid (CSF), there is potential for EVD associated acute bacterial meningitis (EVD-AM). Post-craniotomy, in patients with EVDs, one or more CSF abnormalities are commonly present making the diagnosis of EVD-AM problematic. EVD-AM was defined as elevated CSF lactic acid (>6 nmol/L), plus CSF marked pleocytosis (>50 WBCs/mm(3)), plus a positive Gram stain (same morphology as CSF isolate), plus a positive CSF culture of neuropathogen (same morphology as Gram stained organism). We reviewed 22 adults with EVDs to determine if our four CSF parameters combined accurately identified EVD-AM. No single or combination of <4 CSF parameters correctly diagnosed or ruled out EVD-AM. Combined our four CSF parameters clearly differentiated EVD-AM from one case of pseudomeningitis due to E. cloacae. We conclude that our four CSF criteria combined are useful in diagnosing EVD-AM in adults.
authors: Infectious Disease Division, Winthrop-University Hospital, Mineola, NY, USA.
authors: Sigridh
authors: S
authors: Muñoz-Gómez
authors: Department of Neurosciences, Winthrop-University Hospital, Mineola, NY, USA; State University of New York, School of Medicine, Stony Brook, NY, USA.
authors: Elizabeth
authors: E
authors: Wirkowski
authors: Infectious Disease Division, Winthrop-University Hospital, Mineola, NY, USA; State University of New York, School of Medicine, Stony Brook, NY, USA. Electronic address: bacunha@winthrop.org.
authors: Burke A
authors: BA
authors: Cunha
mesh_terms: D000328:Adult; D003399:Craniotomy; D003428:Cross Infection / Q000175:diagnosis*; D004322:Drainage / Q000295:instrumentation; D006801:Humans; D019344:Lactic Acid / Q000134:cerebrospinal fluid; D008581:Meningitis / Q000175:diagnosis*; D012189:Retrospective Studies
chemical_list: D019344:Lactic Acid
keywords: EVD associated meningitis; Gram negative bacillary meningitis; Meningitis mimics; Nosocomial meningitis; Pseudomeningitis