Clinical and Laboratory Characteristics for the Diagnosis of Bacterial Ventriculitis After Aneurysmal Subarachnoid Hemorrhage

W. P. Vandertop,D. Verbaan,D. van de Beek,J. Horn,J. Hoogmoed,B. A. Coert

doi:10.1007/s12028-016-0345-8

W. P. Vandertop, D. Verbaan + Show 4 more

Open Access

https://doi.org/10.1007/s12028-016-0345-8

Copy DOI

Journal: Neurocritical Care	Publication Date: Dec 21, 2016
Citations: 17	License type: open-access

Affiliation: Academic Medical Center

Abstract

BackgroundThe diagnosis of nosocomial bacterial ventriculitis in patients with subarachnoid hemorrhage (SAH) can be challenging.MethodsWe 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.ResultsEmpirical 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.ConclusionsNosocomial 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.

Highlights

Infections in patients with a subarachnoid hemorrhage (SAH), mainly pneumonia, urinary tract infections, blood stream infections, or bacterial ventriculitis, are independently associated with a prolonged stay in the intensive care unit (ICU), a poor outcome and increased mortality [1, 2]
Within the group of suspected ventriculitis, only longer duration of CSF drainage and lower CSF red blood cell counts predicted for culture positivity
Forty-eight (23 %) patients were treated with antibiotics for a clinical suspicion of bacterial ventriculitis, and CSF

Summary

Introduction

Infections in patients with a subarachnoid hemorrhage (SAH), mainly pneumonia, urinary tract infections, blood stream infections, or bacterial ventriculitis, are independently associated with a prolonged stay in the intensive care unit (ICU), a poor outcome and increased mortality [1, 2]. Bacterial ventriculitis is reported in 3–29 % of SAH patients [2,3,4,5,6] and is strongly associated with the placement of CSF (cerebrospinal fluid) catheters [5, 7]. In studies on external catheterrelated bacterial ventriculitis, subgroup analyses for SAH patients have not been performed [9,10,11,12,13,14,15,16]. The diagnosis of nosocomial bacterial ventriculitis in patients with subarachnoid hemorrhage (SAH) can be challenging

Methods

Results

Conclusion