Comparing External Ventricular Drains-Related Ventriculitis Surveillance Definitions

Area of Science:

• Infectious Diseases
• Neurocritical Care
• Healthcare Epidemiology

Background:

• External ventricular drains (EVDs) are crucial for managing neurological conditions but carry a risk of ventriculitis.
• Current surveillance definitions for ventriculitis, like the National Healthcare Safety Network (NHSN) criteria, may lack precision.
• Variability in diagnostic criteria can hinder accurate infection rate comparisons between institutions.

Purpose of the Study:

• To assess the agreement between the NHSN definition of ventriculitis and other published criteria in patients with EVDs.
• To identify limitations in current definitions that impact surveillance consistency.

Main Methods:

• Retrospective cohort study of patients with EVDs from January 2009 to December 2014.
• Inclusion of patients with positive cerebrospinal fluid (CSF) cultures or abnormal CSF results during EVD monitoring.
• Application of multiple ventriculitis definitions (NHSN, Honda, Gozal, Citerio) to patient data.

Main Results:

• Fifty-two cases of ventriculitis were identified using the NHSN definition, predominantly caused by gram-positive commensals.
• Significant overlap was observed: ~60% met Honda criteria, ~56% met Gozal criteria, and 23% met Citerio's definition.
• Agreement between definitions ranged from moderate (Honda vs. Gozal, κ=0.528) to fair (Honda vs. Citerio, κ=0.338; Citerio vs. Gozal, κ=0.384).

Conclusions:

• Published definitions for ventriculostomy-associated infections (VAI) demonstrate moderate to fair agreement in this patient cohort.
• A more precise VAI surveillance definition is required to improve standardization and comparability of infection rates across healthcare facilities.
• Refining definitions to better distinguish true infections from contaminants is essential for accurate VAI surveillance.