Utility of the Cell Index in Predicting External Ventricular Drain-Related Ventriculo-Meningitis.
Cell index
Cerebral ventriculitis
Cerebrospinal fluid
Neurosurgery
Ventriculostomy
Journal
Neurocritical care
ISSN: 1556-0961
Titre abrégé: Neurocrit Care
Pays: United States
ID NLM: 101156086
Informations de publication
Date de publication:
12 2020
12 2020
Historique:
pubmed:
22
4
2020
medline:
24
9
2021
entrez:
22
4
2020
Statut:
ppublish
Résumé
Ventriculo-meningitis (VM) is an important complication of external ventricular drains (EVDs) in neurosurgical patients. Consequences include increased morbidity, mortality, and duration of hospital stay. Early diagnosis of EVD-associated VM allows earlier treatment intervention. The cell index (CI) may provide a simple measure that overcomes the limitations of isolated cerebrospinal fluid (CSF) parameters and other diagnostic tests, allowing earlier prediction of VM. All patients admitted to a tertiary hospital and requiring EVD insertion during 2015 and 2016 were assessed for inclusion in this retrospective case-control study. Patients with a known or suspected intracranial infection were excluded. Of the 186 patients who underwent EVD insertion, 95 patients were included in the final cohort. Data pertaining to patient characteristics and laboratory indices were extracted from health records and the microbiology laboratory database. The CI was calculated as the ratio of temporally related CSF leukocytes/erythrocytes to peripheral blood leukocytes/erythrocytes. Data from patients with microbiologically confirmed VM were analyzed in comparison with those not developing VM during the course of their stay. Categorical and continuous variables with skewed distributions were analyzed by Chi square and Mann-Whitney tests, respectively. EVD-associated VM developed in 7.4% of patients. The highest CSF CI (within 3 days prior to diagnosis of VM or at any time for those not developing VM) differed significantly between the two groups (16; IQR 10.8-48.5 vs. 3.3; IQR 1.0-12.8, respectively; p = .046). The area under the receiver operating characteristic curve (AUROC) for the highest CI was 0.727 (95% confidence interval [CI] 0.526-0.929; p = .027). A CI of 10.4 provided a sensitivity and specificity of 80.5% and 70.5%, respectively, for the early diagnosis of VM. In neurosurgical patients with an EVD, the CSF CI significantly predicted the development of VM.
Sections du résumé
BACKGROUND/OBJECTIVE
Ventriculo-meningitis (VM) is an important complication of external ventricular drains (EVDs) in neurosurgical patients. Consequences include increased morbidity, mortality, and duration of hospital stay. Early diagnosis of EVD-associated VM allows earlier treatment intervention. The cell index (CI) may provide a simple measure that overcomes the limitations of isolated cerebrospinal fluid (CSF) parameters and other diagnostic tests, allowing earlier prediction of VM.
METHODS
All patients admitted to a tertiary hospital and requiring EVD insertion during 2015 and 2016 were assessed for inclusion in this retrospective case-control study. Patients with a known or suspected intracranial infection were excluded. Of the 186 patients who underwent EVD insertion, 95 patients were included in the final cohort. Data pertaining to patient characteristics and laboratory indices were extracted from health records and the microbiology laboratory database. The CI was calculated as the ratio of temporally related CSF leukocytes/erythrocytes to peripheral blood leukocytes/erythrocytes. Data from patients with microbiologically confirmed VM were analyzed in comparison with those not developing VM during the course of their stay. Categorical and continuous variables with skewed distributions were analyzed by Chi square and Mann-Whitney tests, respectively.
RESULTS
EVD-associated VM developed in 7.4% of patients. The highest CSF CI (within 3 days prior to diagnosis of VM or at any time for those not developing VM) differed significantly between the two groups (16; IQR 10.8-48.5 vs. 3.3; IQR 1.0-12.8, respectively; p = .046). The area under the receiver operating characteristic curve (AUROC) for the highest CI was 0.727 (95% confidence interval [CI] 0.526-0.929; p = .027). A CI of 10.4 provided a sensitivity and specificity of 80.5% and 70.5%, respectively, for the early diagnosis of VM.
CONCLUSIONS
In neurosurgical patients with an EVD, the CSF CI significantly predicted the development of VM.
Identifiants
pubmed: 32314243
doi: 10.1007/s12028-020-00964-w
pii: 10.1007/s12028-020-00964-w
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
776-784Références
Williamson RA, Phillips-Bute BG, McDonagh DL, et al. Predictors of extraventricular drain-associated bacterial ventriculitis. J Crit Care. 2014;29:77–82.
doi: 10.1016/j.jcrc.2013.08.012
Rahman M, Whiting JH, Fauerbach LL, et al. Reducing ventriculostomy-related infections to near zero: the eliminating ventriculostomy infection study. Jt Comm J Qual Patient Saf. 2012;38(10):459–64.
pubmed: 23130392
Humphreys H, Jenks PJ. Surveillance and management of ventriculitis following neurosurgery. J Hosp Infect. 2015;89:281–6.
doi: 10.1016/j.jhin.2014.12.019
Pfisterer W, Muhlbauer M, Czech T, et al. Early diagnosis of external ventricular drainage infection: results of a prospective study. J Neurol Neurosurg Psychiatry. 2003;74:929–32.
doi: 10.1136/jnnp.74.7.929
Murthy SB, Moradiya Y, Shah J, et al. Incidence, predictors and outcomes of ventriculostomy associated infections in spontaneous intracerebral hemorrhage. Neurocrit Care. 2016;24:389–96.
doi: 10.1007/s12028-015-0199-5
Beer R, Lackner P, Pfausler B, et al. Nosocomial ventriculitis and meningitis in neurocritical care patients. J Neurol. 2008;255:1617–24.
doi: 10.1007/s00415-008-0059-8
Schade RP, Schinkel J, Roelandse FWC, et al. Lack of value of routine analysis of cerebrospinal fluid for prediction and diagnosis of external drainage-related bacterial meningitis. J Neurosurg. 2006;104:101–8.
doi: 10.3171/jns.2006.104.1.101
Martin RM, Zimmermann LL, Huynh M, Polage CR. Diagnostic approach to health care and device-associated central nervous system infections. J Clin Microbiol. 2018;56:e00861-18.
doi: 10.1128/JCM.00861-18
Beer R, Pfausler B, Schmutzhard E. Management of nosocomial external ventricular drain-related ventriculomeningitis. Neurocrit Care. 2009;10:363–7.
doi: 10.1007/s12028-008-9155-y
Lozier AP, Sciacca RR, Romagnoli MF, et al. Ventriculostomy-related infections: a critical review of the literature. Neurosurgery. 2002;51:170–82.
doi: 10.1097/00006123-200207000-00024
Tunkell AR, Hasbun R, Bhimraj A, et al. Infectious diseases society of America’s Clinical practice guidelines for healthcare-associated ventriculitis and meningitis. Clin Infect Dis. 2017;64(6):e34–365.
doi: 10.1093/cid/ciw861
Gordon M, Ramirez P, Soriano A, et al. Diagnosing external ventricular drain-related ventriculitis by means of local inflammatory response: soluble triggering receptor expressed on myeloid cells-1. Crit Care. 2014;18:567.
doi: 10.1186/s13054-014-0567-0
Wiegand J, Hickson L, Merz TM. Indicators of external drainage-related infections—a retrospective observational study. Acta Neurochir. 2016;158:595–601.
doi: 10.1007/s00701-016-2709-4
Montes K, Jenkinson H, Habib OB, et al. Corrected white blood cell count, cell index, and validation of a clinical model for the diagnosis of health care-associated ventriculitis and meningitis in adults with intracranial hemorrhage. Clin Neurol Neurosurg. 2019;178:36–41.
doi: 10.1016/j.clineuro.2019.01.012
Hoogmoed J, van de Beek D, Coert BA, et al. Clinical and laboratory characteristics for the diagnosis of bacterial ventriculitis after aneurysmal subarachnoid hemorrhage. Neurocrit Care. 2017;26:362–70.
doi: 10.1007/s12028-016-0345-8
Lenski M, Huge V, Schmutzer M, et al. Inflammatory markers in serum and cerebrospinal fluid for early detection of external ventricular drain-associated ventriculitis in patients with subarachnoid hemorrhage. J Neurosurg Anesthesiol. 2019;31:227–33.
doi: 10.1097/ANA.0000000000000496
Brown EM, de Louvois J, Bayston R, et al. The management of neurosurgical patients with postoperative bacterial or aseptic meningitis or external ventricular drain-associated ventriculitis. Br J Neurosurg. 2000;14(1):7–12.
doi: 10.1080/02688690042834
Mayhall CG, Archer NH, Lamb VA, et al. Ventriculostomy-related infections: a prospective epidemiologic study. N Eng J Med. 1984;310:553–9.
doi: 10.1056/NEJM198403013100903
Pfausler B, Beer R, Engelhardt K, et al. Cell Index- a new parameter for the early diagnosis of ventriculostomy (external ventricular drainage)-related ventriculitis is patients with intraventricular hemorrhage? Acta Neurochir. 2004;146:477–81.
doi: 10.1007/s00701-004-0258-8
Rath PM, Schoch B, Adamzik M, et al. Value of multiplex PCR using cerebrospinal fluid for the diagnosis of Ventriculostomy-related meningitis in neurosurgery patients. Infection. 2014;42:621–7.
doi: 10.1007/s15010-014-0590-8
Schoch B, Regel JP, Nierhaus A, et al. Predictive Value of Intrathecal Interleukin-6 for ventriculostomy-related infection. Zentralbl Neurochir. 2008;69:80–6.
doi: 10.1055/s-2007-1022559
Boeer K, Vogelsang H, Deufel T, et al. Immediate diagnosis of ventriculitis: evaluation of parameters independent of microbiological culture. Acta Neurochir. 2011;153:1797–805.
doi: 10.1007/s00701-011-1079-1
CDC/NHSN Surveillance Definitions for Specific Types of Infections January 2019. https://www.cdc.gov/nhsn/PDFs/pscManual/17pscNosInfDef_current.pdf . Accessed 10 July 2019.