title: Clinical, biological, and microbiological pattern associated with ventriculostomy-related infection: a retrospective longitudinal study.
abstract: BACKGROUND
  Our aim was to describe the pattern of ventriculostomy-related infection (VRI) development using a dynamic approach.
  
  
  METHODS
  Retrospective longitudinal study.
  
  
  METHODS
  We analyzed the files of 449 neurosurgical patients who underwent placement of external ventricular drain (EVD). During the study period, CSF sampling was performed on a daily base setting. VRI was defined as a positive CSF culture resulting in antibiotic treatment. For VRI patients, we arbitrary defined day 0 (D0) as the day antibiotic treatment was started. In these patients, we compared dynamic changes in clinical and biological parameters at four pre-determined time points: (D-4, D-3, D-2, D-1) with those of D0. For all CSF-positive cultures, we compared CSF biochemical markers' evolution pattern between VRI patients and the others, considered as a control cohort.
  
  
  RESULTS
  Thirty-two suffered from VRI. Peripheral white blood cell count did not differ between D-4-D0. Median body temperature, CSF cell count, median Glasgow Coma Scale, CSF protein, and glucose concentrations were significantly different between D-4, D-3, D-2, and D0. At D0, 100 % of CSF samples yielded organisms in culture. The physician caring for the patient decided to treat VRI based upon positive CSF culture in only 28 % (9/32) of cases. In the control cohort, CSF markers' profile trends to normalize, while it worsens in the VRI patients.
  
  
  CONCLUSIONS
  We showed that clinical symptoms and biological abnormalities of VRI evolved over time. Our data suggest that VRI decision to treat relies upon a bundle of evidence, including dynamic changes in CSF laboratory exams combined with microbiological analysis.
authors.affiliation: Department of Anesthesia and Surgical Intensive Care, Henri Mondor University Hospital of Paris, Paris XII School of Medicine, 94000, Créteil, France. roman.mounier@laposte.net.|Anesthesia and Surgical Intensive Care Department, Henri Mondor University Hospital, 51, Avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France. roman.mounier@laposte.net.
authors.forename: Roman
authors.initials: R
authors.lastname: Mounier
authors.affiliation: Department of Anesthesia and Surgical Intensive Care, Henri Mondor University Hospital of Paris, Paris XII School of Medicine, 94000, Créteil, France.
authors.forename: David
authors.initials: D
authors.lastname: Lobo
authors.affiliation: Department of Anesthesia and Surgical Intensive Care, Henri Mondor University Hospital of Paris, Paris XII School of Medicine, 94000, Créteil, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Cook
authors.affiliation: Department of Anesthesia and Surgical Intensive Care, Henri Mondor University Hospital of Paris, Paris XII School of Medicine, 94000, Créteil, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Fratani
authors.affiliation: Department of Anesthesia and Surgical Intensive Care, Henri Mondor University Hospital of Paris, Paris XII School of Medicine, 94000, Créteil, France.
authors.forename: Arie
authors.initials: A
authors.lastname: Attias
authors.affiliation: Department of Anesthesia and Surgical Intensive Care, Henri Mondor University Hospital of Paris, Paris XII School of Medicine, 94000, Créteil, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Martin
authors.affiliation: Department of Anesthesia and Surgical Intensive Care, Henri Mondor University Hospital of Paris, Paris XII School of Medicine, 94000, Créteil, France.
authors.forename: Karin
authors.initials: K
authors.lastname: Chedevergne
authors.affiliation: Department of Anesthesia and Surgical Intensive Care, Henri Mondor University Hospital of Paris, Paris XII School of Medicine, 94000, Créteil, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Bardon
authors.affiliation: Department of Neurosurgery, Henri Mondor University Hospital of Paris, Paris XII School of Medicine, 94000, Créteil, France.
authors.forename: Sanaa
authors.initials: S
authors.lastname: Tazi
authors.affiliation: Department of Microbiology, Henri Mondor University Hospital of Paris, Paris XII School of Medicine, 94000, Créteil, France.
authors.forename: Biba
authors.initials: B
authors.lastname: Nebbad
authors.affiliation: Department of Anesthesia and Surgical Intensive Care, Henri Mondor University Hospital of Paris, Paris XII School of Medicine, 94000, Créteil, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Bloc
authors.affiliation: Department of Anesthesia and Surgical Intensive Care, Henri Mondor University Hospital of Paris, Paris XII School of Medicine, 94000, Créteil, France.
authors.forename: Benoît
authors.initials: B
authors.lastname: Plaud
authors.affiliation: Department of Anesthesia and Surgical Intensive Care, Henri Mondor University Hospital of Paris, Paris XII School of Medicine, 94000, Créteil, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Dhonneur
mesh_terms: D003428:Cross Infection / Q000134:cerebrospinal fluid / Q000209:etiology*; D004322:Drainage / Q000009:adverse effects; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008581:Meningitis / Q000134:cerebrospinal fluid / Q000209:etiology*; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D014696:Ventriculostomy / Q000009:adverse effects*
keywords: Cerebrospinal fluid; Cerebrospinal fluid culture; Diagnosis; External ventricular drain; Nosocomial meningitis; Ventriculostomy-related infection