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Acta Neurochirurgica

, Volume 160, Issue 10, pp 2039–2047 | Cite as

Modalities and accuracy of diagnosis of external ventricular drainage-related infections: a prospective multicentre observational cohort study

  • J. Berger-Estilita
  • M. Passer
  • M. Giles
  • J. Wiegand
  • Tobias M. MerzEmail author
Original Article - Neurosurgical intensive care
Part of the following topical collections:
  1. Neurosurgical intensive care

Abstract

Background

Device infection is a major complication of placement external ventricular drains (EVD). Diagnostic features are often masked by underlying disease or cerebrospinal fluid (CSF) contamination by blood. We aim to assess which diagnostic modalities are applied for EVD-related infection (ERI) diagnosis and evaluate their accuracy.

Methods

This observational prospective study included 187 adult patients with an EVD. Modalities of clinical diagnosis of ERI diagnosed by treating physicians on clinical grounds and blood and CSF analysis (clinically diagnosed ERI (CD-ERI)) were assessed prospectively. Additionally, the diagnostic accuracy of clinical and laboratory parameters for the diagnosis of culture proven ERI (CP-ERI) was evaluated, using data of the study patients and including a retrospective cohort of 39 patients with CP-ERI.

Results

Thirty-one CD-ERIs were diagnosed in the prospective cohort. Most physicians used CSF analysis to establish the diagnosis. ROC analysis revealed an AUC of 0.575 (p = 0.0047) for the number of positive SIRS criteria and AUC of 0.5420 (p = 0.11) for the number of pathological neurological signs for diagnosis of CP-ERI. Diagnostic accuracy of laboratory values was AUC 0.596 (p = 0.0006) for serum white blood cell count (WBCC), AUC 0.550 (p = 0.2489) for serum C-reactive protein, AUC 0.644 (p < 0.0001) for CSF WBCC and AUC 0.690 for CSF WBC/red blood cell count ratio (both p < 0.0001). Neither a temporal trend in potential predictors of CP-ERI nor a correlation between clinical diagnosis and proven CSF infection was found.

Conclusions

Clinicians base their diagnosis of ERI mostly on CSF analysis and occurrence of fever, leading to over-diagnosis. The accuracy of the clinical diagnosis is low. Commonly used clinical and laboratory diagnostic criteria have a low sensitivity and specificity for ERI.

Keywords

External ventricular device EVD-related infection Diagnosis CSF changes 

Abbreviations

AB

Antibiotic

AUC

Area under the curve

AUROC

Area under the ROC curve

CD-ERI

Clinically diagnosed EVD-related infection

CP-ERI

Culture-proven EVD-related infection

CSF WBCC

CSF white blood cell count

CNS

Central nervous system

CoNS

Coagulase-negative staphylococci

CRP

C-reactive protein

CSF

Cerebrospinal fluid

ERI

EVD-related infection

EVD

External ventricular drain

GCS

Glasgow Coma Score

GOS

Glasgow Outcome Score

ICH

Intracerebral haemorrhage

ICP

Intracerebral pressure

ICU

Intensive care unit

LOS

Length of hospital stay

PMN

Polymorphonuclear neutrophils

RBC

Red blood cell

RBCC

Red blood cell count

ROC

Receiver operating characteristic

S-CRP

Serum C-reactive protein

S-WBCC

Serum white blood cell count

SAH

Subarachnoid haemorrhage

SIRS

Systemic inflammatory response syndrome

TBI

Traumatic brain injury

WBC

White blood cell

Notes

Compliance with ethical standards

The study protocol was reviewed and approved by the relevant institutional review boards (Ethics Committee Bern, Switzerland; the Alfred Health Ethics Committee, Melbourne, Australia; and the Hawkesbury Human Research Ethics Committee, Northern Sydney Central Coast Health, Australia). All procedures were in accordance with the institutional and national research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Due to the observational nature of the study, which only used data obtained during routine care, formal consent is not required.

Conflict of interest

The authors declare that they have no conflict of interest.

Human and animal rights

This article does not contain any studies with animals performed by any of the authors.

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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  • J. Berger-Estilita
    • 1
  • M. Passer
    • 2
  • M. Giles
    • 2
  • J. Wiegand
    • 3
  • Tobias M. Merz
    • 4
    Email author
  1. 1.Department of Anaesthesiology and Pain Therapy, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
  2. 2.Department of Intensive Care Medicine, Royal North Shore HospitalUniversity of SydneySydneyAustralia
  3. 3.Intensive Care UnitLindenhofspitalBernSwitzerland
  4. 4.Department of Intensive Care Medicine, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland

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