Comparison of Suspected and Confirmed Internal External Ventricular Drain-Related Infections: A Prospective Multicenter United Kingdom Observational Study
Author:
Sohn Sei Yon1ORCID, Russell Clark D2, Jamjoom Aimun A B3, Poon Michael T3, Lawson McLean Aaron4, Ahmed Aminul I5, Abdulla MAH, Alalade A, Bailey M, Basu S, Baudracco I, Bayston R, Bhattacharya A, Bodkin P, Boissaud-Cooke M, Bojanic S, Brennan PM, Bulters DO, Buxton N, Chari A, Corns R, Coulter C, Coulter I, Critchley G, Dando A, Dardis R, Duddy J, Dyson E, Edwards R, Garnett M, Gatcher S, Georges H, Glancz LJ, Gray WP, Hallet J, Harte J, Haylock-Vize P, Hutchinson PJ, Humphreys H, Jenkinson MD, Joannides AJ, Kandasamy J, Kitchen J, Kolias AG, Loan JJM, Ma R, Madder H, Mallucci CL, Manning A, Mcelligott S, Mukerji N, Narayanamurthy H, O’Brien D, Okasha M, Papadopoulos M, Phan V, Phang I, Poots J, Rajaraman C, Roach J, Ross N, Sharouf F, Shastin D, Simms N, Steele L, Solth A, Tajsic T, Talibi S, Thanabalasundaram G, Vintu M, Wan Y, Wang D, Watkins L, Whitehouse K, Whitfield PC, Williams A, Zaben M,
Affiliation:
1. Division of Anaesthesia, University of Cambridge , Cambridge , United Kingdom 2. Queen's Medical Research Institute, University of Edinburgh Centre for Inflammation Research , Edinburgh , United Kingdom 3. Department of Clinical Neuroscience, Royal Infirmary of Edinburgh , Edinburgh , United Kingdom 4. Department of Neurosurgery, Jena University Hospital – Friedrich Schiller University Jena , Jena , Germany 5. Department of Neurosurgery, Wolfson CARD, King's College London, King's College Hospital , London , United Kingdom
Abstract
Abstract
Background
Diagnosis of internal external ventricular drain (EVD)-related infections (iERI) is an area of diagnostic difficulty. Empiric treatment is often initiated on clinical suspicion. There is limited guidance around antimicrobial management of confirmed versus suspected iERI.
Methods
Data on patients requiring EVD insertion were collected from 21 neurosurgical units in the United Kingdom from 2014 to 2015. Confirmed iERI was defined as clinical suspicion of infection with positive cerebrospinal fluid (CSF) culture and/or Gram stain. Cerebrospinal fluid, blood, and clinical parameters and antimicrobial management were compared between the 2 groups. Mortality and Modified Rankin Scores were compared at 30 days post-EVD insertion.
Results
Internal EVD-related infection was suspected after 46 of 495 EVD insertions (9.3%), more common after an emergency insertion. Twenty-six of 46 were confirmed iERIs, mostly due to Staphylococci (16 of 26). When confirmed and suspected infections were compared, there were no differences in CSF white cell counts or glucose concentrations, nor peripheral blood white cell counts or C-reactive protein concentrations. The incidence of fever, meningism, and seizures was also similar, although altered consciousness was more common in people with confirmed iERI. Broad-spectrum antimicrobial usage was prevalent in both groups with no difference in median duration of therapy (10 days [interquartile range {IQR}, 7–24.5] for confirmed cases and 9.5 days [IQR, 5.75–14] for suspected, P = 0.3). Despite comparable baseline characteristics, suspected iERI was associated with lower mortality and better neurological outcomes.
Conclusions
Suspected iERI could represent sterile inflammation or lower bacterial load leading to false-negative cultures. There is a need for improved microbiology diagnostics and biomarkers of bacterial infection to permit accurate discrimination and improve antimicrobial stewardship.
Funder
Edinburgh Clinical Academic Track Wellcome Trust PhD Training Fellowship for Clinicians
Publisher
Oxford University Press (OUP)
Subject
Infectious Diseases,Oncology
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