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Ventriculostomy-associated infection: a new, standardized reporting definition and institutional experience
Yair M Gozal1, Chad W Farley, Dennis J Hanseman
1Department of Neurosurgery, University of Cincinnati College of Medicine, ML 0515, Cincinnati, OH, 45267-0515, USA.
Objective:
Shortcomings created by the lack of both a uniform definition of ventriculostomy-associated infection (VAI) and reporting standards have led to widely ranging infections rates (2-24%) whose significance is uncertain. We propose a standardized definition of VAI and a consistent reporting format compliant with Centers for Disease Control and Prevention (CDC) for device-related infections. Using those parameters to establish an infection-control surveillance program, we report our 4-year institutional VAI rates.
Methods:
In this prospective study covering ventriculostomy utilization (October 2006-December 2010), 498 patients had a total of 4,673 ventriculostomy days. By review of the literature and our institutional analysis, we defined VAI as a positive CSF culture in a patient with ventriculostomy catheter, plus one or more of the following (1) fever recorded >101.5 °F or (2) cerebrospinal fluid (CSF) glucose level, either <50 mg/dL or <50% of a serum glucose level drawn within 24 h of the CSF glucose. In a report format that is CDC compliant, rates of VAI are reported.
Results:
Among our patients, the CDC-compliant infection rate was 2.14 per 1,000 ventriculostomy days. Of the 10 VAIs occurring in 498 patients during 4,673 ventriculostomy days, this 2.0% infection rate was lower than the previously reported 8.8% composite rates of VAI. Average duration of ventriculostomy was 9.4 days. Neither antibiotic-impregnated catheters nor periprocedural or prophylactic antibiotics were used.
Conclusions:
Our standardized VAI definition and CDC format seems promising toward facilitating future study and guideline development. Given our strict protocol of sterile catheter placement and care, and our institution's low 2.0% infection rates, we propose an infection-rate target of ≤5 per 1,000 device days. Our results suggest that the use of antibiotics or antibiotic-impregnated catheters is unwarranted--a positive given concerns of evolving anti-microbial resistance.
Insights
A standardized definition for ventriculostomy-associated infection (VAI) and CDC reporting led to a low 2.0% institutional infection rate. This suggests antibiotic use may be unnecessary, aiding antimicrobial resistance concerns.
Area of Science:
- Neuroscience
- Infectious Diseases
- Medical Device Infections
Background:
- Ventriculostomy-associated infections (VAI) lack uniform definitions and reporting standards, leading to variable infection rates (2-24%).
- This ambiguity hinders accurate assessment and comparison of VAI risks and the effectiveness of infection control measures.
Purpose of the Study:
- To propose a standardized definition for VAI and a Centers for Disease Control and Prevention (CDC)-compliant reporting format.
- To establish an infection-control surveillance program using these standardized parameters.
- To report the 4-year institutional VAI rates based on the new definition and reporting format.
Main Methods:
- A prospective study analyzed 498 patients with 4,673 ventriculostomy days (October 2006-December 2010).
- VAI was defined as positive CSF culture plus fever (>101.5 °F) or abnormal CSF glucose (<50 mg/dL or <50% of serum glucose).
- Infection rates were reported using a CDC-compliant format.
Main Results:
- The institutional VAI rate was 2.14 per 1,000 ventriculostomy days (2.0% overall).
- This rate is significantly lower than previously reported composite rates (8.8%).
- No antibiotic-impregnated catheters or prophylactic antibiotics were used.
Conclusions:
- The standardized VAI definition and CDC reporting format are effective for surveillance and future research.
- A target VAI rate of ≤5 per 1,000 device days is proposed.
- The findings suggest that antibiotics or impregnated catheters may be unwarranted, addressing concerns about antimicrobial resistance.
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