Comparison between Institutionally-Defined Clinical Criteria and CDC-Criteria for the Diagnosis of Ventriculostomy-Related Infection (P02.220)

Abstract

Objective: To compare our clinical criteria for ventriculostomy-related infections (VRIs) to the Centers for Disease Control (CDC) criteria. Background The diagnosis of VRI is commonly made based upon clinical impression rather than utilizing specific criteria, which may result in misdiagnoses and overutilization of antibiotics. Design/Methods: A prospective observational study of VRI was conducted between August 2009 and April 2011. Patients were excluded due to death within three days of EVD insertion, EVD insertion at an outside hospital >1 day before transfer, or pre-insertion CNS infection. CSF was sampled every other day and additionally for clinical suspicion of VRI. Clinical criteria for VRI was fever (T≥38.3C) accompanied by an increase in CSF white blood cells (WBCs) and/or decrease in CSF glucose. CDC-defined VRI was concurrently diagnosed by an infectious disease epidemiologist. Both the epidemiologist and treating team were blinded to the other9s diagnosis. Results: A total of 133 patients met criteria. Mean age was 57 years and 52% were female. The majority of diagnoses were subarachnoid hemorrhage (n=63, 47%) and intracerebral hemorrhage (n=44, 33%). There were 31 (23%) patients diagnosed and treated for VRI using clinical criteria. Of all treated patients, 13 (42%) had CDC-defined VRI and only one (3%) had positive CSF cultures. There was no difference in maximum daily temperature or CSF WBCs, protein, or glucose between those with CDC-defined VRI and those treated who did not meet CDC criteria. In addition, two patients not empirically treated developed culture-positive ventriculitis. The positive predictive value of our clinical diagnosis as compared to CDC criteria was only 42%; negative predictive value was 98%. Conclusions: The majority (58%) of patients diagnosed with VRI by clinical criteria did not meet CDC criteria, raising concern for antibiotic overuse. Improved clinical parameters for defining VRI must be developed for more precise management. Disclosure: Dr. Czeisler has nothing to disclose. Dr. Choi has nothing to disclose. Dr. Guo has nothing to disclose. Dr. Bernstein has nothing to disclose. Dr. Presciutti has nothing to disclose. Dr. Lantigua has nothing to disclose. Dr. Carpenter has nothing to disclose. Dr. Zhang has nothing to disclose. Dr. Ko has nothing to disclose. Dr. Schmidt has nothing to disclose. Dr. Claassen has nothing to disclose. Dr. Mayer has received personal compensation for activities with Astellas Pharmaceuticals, General Electric, Medivance, Inc., Acorda Therapeutics, Actelion, the Medicines Company, Sanofi-Aventis Pharmaceuticals, Inc., Edge Therapeutics, Novartis, Codman, Baxter, and Orsan. Dr. Mayer has received research support from Non-Invasive Medical Systems, Inc. Dr. Lee has received personal compensation for activities with UCB Pharmaceuticals, EKR Therapeutics, Boehringer-Ingelheim, Edwards Lifesciences, Medivance, Innercool, and Astellas as a speaker. Dr. Connolly has nothing to disclose. Dr. Badjatia has nothing to disclose.