title: From the Skin to the Brain: Pathophysiology of Colonization and Infection of External Ventricular Drain, a Prospective Observational Study.
abstract: Ventriculostomy-related infection (VRI) is a serious complication of external ventricular drain (EVD) but its natural history is poorly studied. We prospectively tracked the bacteria pathways from skin towards ventricles to identify the infectious process resulting in ventriculostomy-related colonization (VRC), and VRI. We systematically sampled cerebrospinal fluid (CSF) on a daily basis and collected swabs from both the skin and stopcock every 3.0 days for microbiological analysis including in 101 neurosurgical patient. Risk factors for positive event defined as either VRC or VRI were recorded and related to our microbiological findings. A total of 1261 CSF samples, 473 skin swabs, and 450 stopcock swabs were collected. Skin site was more frequently colonized than stopcock (70 (60%) vs 34 (29%), p = 0.023), and earlier (14 ±1.4 vs 24 ±1.5 days, p<0.0001). Sixty-one (52%) and 32 (27%) skin and stopcock sites were colonized with commensal bacteria, 1 (1%) and 1 (1%) with pathogens, 8 (7%) and 1 (1%) with combined pathogens and commensal bacteria, respectively. Sixteen positive events were diagnosed; a cutaneous origin was identified in 69% of cases. The presence of a pathogen at skin site (6/16 vs 4/85, OR: 11.8, [2.5-56.8], p = 0.002) and CSF leakage (7/16 vs 6/85, OR 10 [2.4-41.2], p = 0.001)) were the two independent significant risk factors statistically linked to positive events occurrence. Our results suggest that VRC and VRI mainly results from an extra-luminal progression of pathogens initially colonizing the skin site where CSF leaks.
authors.affiliation: Department of Anesthesia and Surgical Intensive Care, Henri Mondor University Hospital of Paris, Paris XII school of medicine, Créteil, France.
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, 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, 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, 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, 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, Créteil, France.
authors.forename: Bouziane
authors.initials: B
authors.lastname: Aït-Mamar
authors.affiliation: Department of Anesthesia and Surgical Intensive Care, Henri Mondor University Hospital of Paris, Paris XII school of medicine, Créteil, France.
authors.forename: Inanna
authors.initials: I
authors.lastname: Gabriel
authors.affiliation: Department of Neurosurgery, Henri Mondor University Hospital of Paris, Paris XII school of medicine, Créteil, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Bekaert
authors.affiliation: Department of Anesthesia and Surgical Intensive Care, Henri Mondor University Hospital of Paris, Paris XII school of medicine, Créteil, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Bardon
authors.affiliation: Department of Microbiology, Henri Mondor University Hospital of Paris, Paris XII school of medicine, Créteil, France.
authors.forename: Biba
authors.initials: B
authors.lastname: Nebbad
authors.affiliation: Department of Anesthesiology and Surgical Intensive Care, Saint-Louis University Hospital of Paris, Paris VII school of medicine, Paris, 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, Créteil, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Dhonneur
mesh_terms: D001424:Bacterial Infections / Q000175:diagnosis / Q000382:microbiology / Q000503:physiopathology*; D002552:Cerebral Ventricles / Q000382:microbiology*; D002557:Cerebrospinal Fluid Shunts / Q000295:instrumentation*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012867:Skin / Q000382:microbiology*