Ventricular catheter tract hemorrhage as a risk factor for ventriculostomy-related infection

Julie Kim, James Lee, Rui Feng, Alexander Chartrain, Stanislaw Sobotka, Stephen Griffiths, Nirit Weiss, Neha Dangayach, Joshua Bederson, Stephan A. Mayer, Errol Gordon

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

BACKGROUND: Ventriculostomy-related infection (VRI) is a feared complication of external ventricular drain (EVD) placement. Although many contributing factors to VRI have been examined, little is known whether there is an association between ventriculostomy-related catheter tract hemorrhage (VCTH) and VRI. OBJECTIVE: To evaluate risk factors for VRI and assess possible correlations with VCTH. METHODS: We performed a retrospective analysis of patients with EVD placement in a neurocritical care unit between 2011 and 2015. VRI was defined as clinical signs of infection with a positive cerebrospinal fluid gram stain and isolation of cerebrospinal fluid culture. VCTH was diagnosed by computed tomography immediately after EVD insertion. RESULTS: A total of 247 patients with EVD were identified during the 5-yr study period. An association between VCTH and gram-negative VRI was identified (P = .02). Ten percent (25 of 247 patients) developed a VRI, and 7% (18 of 247 patients) had a VCTH. Of the 25 patients with VRI, 20% (n = 5) had a VCTH, compared to 6% (n = 13) of 222 patients who had an EVD placed but did not develop VRI. There were no significant differences in demographic and clinical factors except for multiple EVD insertions (P < .00001), EVD duration (P < .001), and hospital length of stay (P < .001). CONCLUSION: VCTH is a potentially significant risk factor for VRI. Further analysis will be needed to confirm the strength of this association, and to delineate the possible mechanisms by which tract hemorrhage may serve as a nidus for bacterial penetration into the central nervous system.

Original languageEnglish
Pages (from-to)69-74
Number of pages6
JournalOperative Neurosurgery
Volume18
Issue number1
DOIs
StatePublished - 1 Jan 2020

Keywords

  • External ventricular drain
  • Gram-negative infections
  • Neurocritical care unit
  • Ventriculostomy-related catheter tract hemorrhage
  • Ventriculostomy-related infection

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