Cerebrospinal fluid devices infection. How are we?
Abstract
Infection is the most common complication of cerebrospinal fluid (CSF) devices. The organisms adhere to the surface and form a biofilm, which difficults clinical diagnosis, laboratory and treatment. OBJECTIVES: Incidence of infection, isolated microorganisms, risk factors, reinfection rate and mortality in a neurosurgical reference hospital. MATERIAL AND METHODS: Retrospective, analytical, observational cohort study. Inclusion criteria: over 15 years old, with CSF devices: EVD and IVD. Period: From June 1, 2020 to June 1, 2022. p<0.05. Multivariate analysis was performed. Epi Info 7. RESULTS: 104 surgical procedures (57 patients); 62% men. Average age: 37 years. Reason for device placement: 57% ventricular hemorrhage, 43% brain trauma, 24% CSF fistula. 20% episodes of infection: 15% ventriculitis (incidence: 17.33/1000 device days) and 5% infections associated with IVD. Most frequent risk factors: CSF fistula (OR 4.75), ventricular hemorrhage (OR 3.65), device stay longer than 5 days (OR 3.76), device replacement (OR 2.76), DVP revision (OR 3.15). Most frequent germs methicillin resistant Staphylococcus epidermidis (19%) and MOMR 24%. Reinfection: 28%. Mortality 10%. CONCLUSION: Infection rate of 20% (reference values according to the literature range from 0 to 22%). Limited reports from Argentina. Risk factors and mortality are similar to those reported in the literature. It is very important to implement prevention and intervention measures in order to minimize the risk of infection to reduce morbidity and mortality and the inappropriate use of antimicrobials. The knowledgement of local data is important.
Downloads
References
2. Dandy W, An operative procedure for hydrocephalus. Bulls Johns Hopkins Hosp 1933; 33:189-90.
3. Wu Y, Green NL, Wrensch MR, Zhao S, Gupta N. “Ventriculoperitoneal shunt complications in California: 1990 to 2000”. Neurosurgery 2007; 61(3): 557-562; discussion 62-63
4. Lan CC, Wong TT, Chen SJ, Liang ML, Tang RB. “Early diagnosis of ventriculoperitoneal shunt infections and malfunctions in children with hydrocephalus”. J Microbiol Immunol Infect 2003; 36(1): 47-50.
5. Tunkel AR, Hasbun R, Bhimraj A, et al. Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. Clin Inf Dis 2017; 64: e34-e65
6. Conen A, Walti LN, Merlo A, Fluckiger U, Battegay M, Trampuz A. Characteristics and treatment outcome of cerebrospinal fluid shunt-associated infections in adults: a retrospective analysis over an 11-year period. Clin Infect Dis 2008; 47:73–82.
7. Ramanan M, Lipman J, Shorr A, Shankar A. A meta-analysis of ventriculostomy-associated cerebrospinal fluid infections. BMC Infect Dis. 2015;15(1):3.
8. Kestle JR, Riva-Cambrin J, Wellons JC, 3rd, et al. “A standardized protocol to reduce cerebrospinal fluid shunt infection: the Hydrocephalus Clinical Research Network Quality Improvement Initiative”. J Neurosurg Pediatr 2011; 8(1): 22-29.
9. McGirt MJ, Zaas A, Fuchs HE, George TM, Kaye K, Sexton DJ. “Risk factors for pediatric ventriculoperitoneal shunt infection and predictors of infectious pathogens”. Clin Infect Dis 2003; 36(7): 858-862.
10. Pena AA, Sandia ZR, Riveros PR, Salazar ZC, Herrera OR, Vergara FR. “Factores de riesgo de infección de derivativa ventrículo peritoneal en pacientes pediátricos del Hospital Carlos Van Buren”. Rev Chilena Infectol 2012; 29(1): 38-43
11. Romero García Misael Vladimir* León Ramírez Ángel Rito Risk factors for infection of ventriculoperitoneal shunt system in pediatric patients ENF INF MICROBIOL 2013 34 (2): 59-63
12. Wang KW, Chang WN, Shih TY, et al. Infection of cerebrospinal fluid shunts: causative pathogens, clinical features, and outcomes. Jpn J Infect Dis 2004; 57:44–8.
13. Morissette I, Gourdeau M, Francoeur J. CSF shunt infections: a fifteen year experience with emphasis on management and outcome. Can J Neurol Sci 1993; 20:118–22
14. Van de Beek D, Drake JM, Tunkel AR. Nosocomial bacterial meningitis. N Engl J Med 2010; 362: 146-54.
15 Governale LS, Fein N, Logsdon J, Black PM. Techniques and complications of external lumbar drainage for normal pressure hydrocephalus. Neurosurgery 2008; 63 (Suppl 2): 379-84.
16 Maskin LP, Capparelli F, Mora A, et al. Cerebrospinal fluid lactate in post-neurosurgical bacterial meningitis diagnosis. Clin Neurol Neurosurg 2013; 115: 1820-5.
17. Pfisterer W, Muhlbauer M, Czech T, Reinprecht A. Early diagnosis of external ventricular drainage infection: results of a prospective study. J Neurol Neurosurg Psychiatry 2003; 74: 929-32.
18. Xiao X, Zhang Y, Zhang L, Kang P, Ji N. The diagnostic value of cerebrospinal fluid lactate for post neurosurgical bacterial meningitis: A meta-analysis. BMC Infect Dis 2016; 16: 483
19 Ulloque-Caamaño L, Mo-Carrascal J, Maraby J, et al. Ventriculitis asociada a drenaje extraventricular: etiología, diagnóstico y tratamiento enfocado a unidades de cuidados neurocríticos. Cir Cir 2019; 87: 230-40.
20 James HE, Walsh JW, Wilson HD, Connor JD, Bean JR, Tibbs PA. Prospective randomized study of therapy in cerebrospinal fluid shunt infection. Neurosurgery 1980; 7: 459-63.
21 Ghosh D, Mainali G, Khera J, Luciano M. Complications of intrathecal baclofen pumps in children: experience from a tertiary care center. Pediatr Neurosurg 2013; 49:138–44 49
22 Walti LN, Conen A et al. Characteristics of infections associated with external ventricular drains of cerebrospinal fluid. J Infect 2013; 66:424–31.
23. Chen HP, Lai CH, Chan YJ, et al. Clinical significance of Acinetobacter species isolated from cerebrospinal fluid. Scand J Infect Dis 2005; 37:669–75.
24 Sacar S, Turgut H, Toprak S, et al. A retrospective study of central nervous system shunt infections diagnosed in a university hospital during a 4-year period. BMC Infect Dis 2006;6:43.,
25 Kanik A, Sırı N, Kose E, et al. Clinical and Economic Results of Ventriculoperitoneal Shunt Infections in Children. Turk Neurosurg 2015;(1):58-62).
26. Soledad González, M.D.a , Mirta Carbonaro. Cerebrospinal fluid shunt-associated infections in pediatrics: Analysis of the epidemiology and mortality risk factors. Arch Argent Pediatr 2018;116(3):198-203
27. Ministerio de Salud R. Argentina. Actualización sobre medidas de prevención de infecciones del sitio quirúrgico INE-SADI 2015. En: https://www.sadi.org.ar/guiasrecomendaciones-y-consensos/item/300-consenso-sadi-ine-prevencion-de-infeccion-de-sitio-quirurgico-2015; consultado julio 2019.
28. Enchev Y. Checklist in neurosurgery to decrease preventable medical errors: A review. Balkan Med J 2015; 32: 337-46.
29. Barker FG 2nd. Efficacy of prophylactic antibiotics against meningitis after craniotomy: a meta-analysis. Neurosurgery 2007; 60: 887-94. Discussion 887-94.
30. Yampolsky C, Ajler P., Management of shunt infections in Schmideck and Sweet Operative Neurosurgical Techniques , 2012 , 97(1151-1155)
Copyright (c) 2024 Laura Flores, Cynthia Rivero, Myrna Cabral, Melisa Martínez Ríos , Maria Laura Vernazzi
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
