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University of Technology of Compiègne, France

Mounier R.,Henri Mondor University Hospital of Paris | Mounier R.,Henri Mondor University Hospital | Lobo D.,Henri Mondor University Hospital of Paris | Cook F.,Henri Mondor University Hospital of Paris | And 10 more authors.
Acta Neurochirurgica | Year: 2015

Background: Our aim was to describe the pattern of ventriculostomy-related infection (VRI) development using a dynamic approach. Study design: 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. © 2015, Springer-Verlag Wien.

Mounier R.,Henri Mondor University Hospital of Paris | Lobo D.,Henri Mondor University Hospital of Paris | Cook F.,Henri Mondor University Hospital of Paris | Martin M.,Henri Mondor University Hospital of Paris | And 8 more authors.
PLoS ONE | Year: 2015

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, [2.5â€"56.8], p = 0.002) and CSF leakage (7/16 vs 6/85, OR 10 [2.4â€"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. © 2015 Mounier et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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