Bacteremia Is a Risk Factor for Cerebrospinal Fluid Infection in Patients with Cerebrospinal Fluid Drains—A Retrospective Study

Charikleia S Vrettou,Evangelos Drosos,Grigorios Gkouvelos,Martha Nepka,Christina Liakopoulou,Anastasia Kotanidou,George Bouboulis,Theodosis Kalamatianos,George Stranjalis

doi:10.3390/bacteria1010005

Charikleia S Vrettou, Evangelos Drosos + Show 7 more

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https://doi.org/10.3390/bacteria1010005

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Abstract

There is little evidence on the role of prior infection in patients with external ventricular drains (EVDs) and lumbar drains (LDs). In this study, our aim is to investigate whether previous bacteremia is a risk factor for cerebrospinal fluid drain infection (CSFDI) in patients with EVDs and LDs and to describe the microorganisms implicated. We designed a retrospective, single-center cohort study. We recorded patients’ demographic and clinical characteristics, as well as microbiology laboratory data. We used non-parametric statistical methods to identify possible risk factors for CSFDI. We found 799 neurosurgical admissions during the study period, 70 of which fulfilled the inclusion criteria. Acinetobacter baumannii was the most frequent single pathogen isolated in the cerebrospinal fluid (CSF). Acinetobacter baumannii bacteremia was more common in patients with Acinetobacter baumannii CSFDI (p = 0.01). The distribution of the pathogens in the CSF differed from that of the pathogens isolated in blood (p = 0.001). In the univariate analysis, prior bacteremia was more common in patients with CSFDI (p = 0.027), but, in the multivariate model, prior bacteremia was not identified as an independent risk factor (OR = 0.456, CI: 0.138–1.512, p = 0.2). In an ICU population, the most frequently isolated pathogens were Gram-negative Enterobacteriaceae and Acinetobacter baumannii. Previous bacteremia was significantly more probable among patients with EVDs or LDs who developed a CSFDI, and its role warrants further investigation.

Highlights

Ill patients with neurological injury and cerebrospinal fluid (CSF) drains often need treatment in an intensive care unit (ICU), where their survival probability can increase
The role of previous infection in the pathogenesis of cerebrospinal fluid drain infection (CSFDI) has, to our knowledge, only been addressed in one study, where prior chest infection was found to be a risk factor for only been addressed in one study, where prior chest infection was found to be a risk for ventriculitis [3]
Fisher’s exact test, comparing the relative frequency of Acinetobacter baumannii CSFDI occurrence between patients with and without Acinetobacter baumannii bacteremia, showed that Acinetobacter baumannii CSFDI was more common in the former (p = 0.01)

Summary

Introduction

Ill patients with neurological injury and cerebrospinal fluid (CSF) drains often need treatment in an intensive care unit (ICU), where their survival probability can increase. Many studies have investigated the risk factors for cerebrospinal fluid drain infection (CSFDI) and the effectiveness of preventive strategies. The role of bacteremia in patients with cerebrospinal fluid (CSFDs) has not been examined, even though bacteremia is a known risk factor fo infection in patients with ventriculoatrial (VA) shunts. In this retrospective stud aim to investigate the possible role of previous, hospital‐acquired4b9 actere a risk factor for CSFDI in a critically ill population with external cerebrospinal fluid d i.e., eithevernetrxictuelritnisa[l3]v. ETnhetrriocleuolaf bradctreareimnisa(iEn VpaDtiesn)tsowr iltuh mcerbebarrosdprinaailnflsu(idLdDrasi)n.s (CSFDs) has not been examined, even though bacteremia is a known risk factor for CSF infection in In this retrospective stud aim to investigate the possible role of previous, hospital‐acquired4b9 actere a risk factor for CSFDI in a critically ill population with external cerebrospinal fluid d i.e., eithevernetrxictuelritnisa[l3]v. eTnhetrriocleuolaf bradctreareimnisa(iEn VpaDtiesn)tsowr iltuh mcerbebarrosdprinaailnflsu(idLdDrasi)n.s (CSFDs) has not been examined, even though bacteremia is a known risk factor for CSF infection in

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