title: Ventriculostomy-related infections: The performance of different definitions for diagnosing infection.
abstract: BACKGROUND
  Comparison of rates of ventriculostomy-related infections (VRIs) across institutions is difficult due to the lack of a standard definition. We sought to review published definitions of VRI and apply them to a test cohort to determine the degree of variability in VRI diagnosis.
  
  
  METHODS
  We conducted a PubMed search for definitions of VRI using the search strings "ventriculostomy-related infection" and "ventriculostomy-associated infection." We applied these definitions to a test cohort of 18 positive cerebrospinal fluid (CSF) cultures taken from ventriculostomies at two institutions to compare the frequency of infection using each definition.
  
  
  RESULTS
  We found 16 unique definitions of VRI. When the definitions were applied to the test cohort, the frequency of infection ranged from 22 to 94% (median 61% with interquartile range (IQR) 56-74%). The concordance between VRI diagnosis and treatment with VRI-directed antibiotics for at least seven days ranged from 56 to 89% (median: 72%, IQR: 71-78%).
  
  
  CONCLUSIONS
  The myriad of definitions in the literature produce widely different frequencies of infection. In order to compare rates of VRI between institutions for the purposes of qualitative metrics and research, a consistent definition of VRI is needed.
authors.affiliation: a Division of Neurocritical Care, Department of Neurology , NYU Langone Medical Center , New York , NY , USA.
authors.forename: Ariane
authors.initials: A
authors.lastname: Lewis
authors.affiliation: b Division of Neurocritical Care and Emergency Neurology, Department of Neurology , Massachusetts General Hospital , Boston , MA , USA.|c Division of Neurocritical Care, Department of Neurology , Harborview Medical Center , Seattle , WA , USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Wahlster
authors.affiliation: a Division of Neurocritical Care, Department of Neurology , NYU Langone Medical Center , New York , NY , USA.|d Columbia University College of Physicians and Surgeons in New York , NY , USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Karinja
authors.affiliation: a Division of Neurocritical Care, Department of Neurology , NYU Langone Medical Center , New York , NY , USA.
authors.forename: Barry M
authors.initials: BM
authors.lastname: Czeisler
authors.affiliation: b Division of Neurocritical Care and Emergency Neurology, Department of Neurology , Massachusetts General Hospital , Boston , MA , USA.
authors.forename: W Taylor
authors.initials: WT
authors.lastname: Kimberly
authors.affiliation: a Division of Neurocritical Care, Department of Neurology , NYU Langone Medical Center , New York , NY , USA.
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Lord
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002408:Catheters, Indwelling / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D014696:Ventriculostomy / Q000009:adverse effects* / Q000379:methods
chemical_list: D000900:Anti-Bacterial Agents
keywords: CSF shunt; cerebrospinal fluid; infection; surgical-site infection; ventriculitis