title: Clinical and Laboratory Characteristics for the Diagnosis of Bacterial Ventriculitis After Aneurysmal Subarachnoid Hemorrhage.
abstract: BACKGROUND
  The diagnosis of nosocomial bacterial ventriculitis in patients with subarachnoid hemorrhage (SAH) can be challenging.
  
  
  METHODS
  We performed a retrospective study on the diagnostic accuracy of clinical and laboratory characteristics for the diagnosis of bacterial ventriculitis in 209 consecutive patients with an aneurysmal SAH admitted in a tertiary referral center from 2008 to 2010. Diagnostic value of clinical characteristics and inflammatory indexes in CSF and blood were determined for three diagnostic categories: (1) no suspicion for bacterial ventriculitis; (2) clinical suspicion for bacterial ventriculitis, defined as initiation of empirical antibiotic treatment for ventriculitis, but negative CSF cultures; and (3) CSF culture-positive bacterial ventriculitis.
  
  
  RESULTS
  Empirical antibiotics for suspected ventriculitis was initiated in 48 of 209 (23 %) patients. CSF cultures were positive in 11 (5 %) patients. Within the group of suspected ventriculitis, only longer duration of CSF drainage and lower CSF red blood cell counts predicted for culture positivity. None of the other clinical features or inflammatory indexes in CSF and blood were associated with culture-proven bacterial ventriculitis.
  
  
  CONCLUSIONS
  Nosocomial bacterial ventriculitis in patients with aneurysmal SAH is often suspected but confirmed by culture in a minority of cases. Improvement of diagnostics for nosocomial bacterial ventriculitis in patients with aneurysmal SAH is needed.
authors.affiliation: Department of Neurosurgery, Neurosurgical Center Amsterdam, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. j.hoogmoed@amc.uva.nl.
authors.forename: J
authors.identifier: http://orcid.org/0000-0002-0749-8070
authors.initials: J
authors.lastname: Hoogmoed
authors.affiliation: Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: van de Beek
authors.affiliation: Department of Neurosurgery, Neurosurgical Center Amsterdam, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: B A
authors.initials: BA
authors.lastname: Coert
authors.affiliation: Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Horn
authors.affiliation: Department of Neurosurgery, Neurosurgical Center Amsterdam, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: W P
authors.initials: WP
authors.lastname: Vandertop
authors.affiliation: Department of Neurosurgery, Neurosurgical Center Amsterdam, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: Verbaan
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D020806:Central Nervous System Bacterial Infections / Q000134:cerebrospinal fluid* / Q000188:drug therapy / Q000209:etiology; D058565:Cerebral Ventriculitis / Q000134:cerebrospinal fluid* / Q000188:drug therapy / Q000209:etiology; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects*; D003428:Cross Infection / Q000134:cerebrospinal fluid* / Q000188:drug therapy / Q000209:etiology; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000601:surgery*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Anti-bacterial agents; Bacterial; Cerebral ventriculitis; Drainage; Infectious ventriculitis; Intensive care units; Meningitis; Neurosurgery; Subarachnoid hemorrhage