Ventriculostomy-Associated Infection (VAI): In Search of a Definition
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We read with great interest the article by Gozal et al. on ventriculostomy-associated infection (VAI) . The authors propose that a standardized definition for VAI should be a CSF microbiological culture that is positive for microorganism and associated with fever or low CSF glucose. While the authors should be commended on their attempt to define VAI with unifying nomenclature and classification in the literature, there is a problem regarding neuroICU patients with ventriculostomy and neurogenic fever: Prone patients such as subarachnoid hemorrhage (SAH) and/or intraventricular hemorrhage (IVH) patients with ventricular catheters who have a CSF microbial contaminant that is not found on repeat CSF testing should be excluded from this definition. The other nosocomial organisms that the authors report, such as MRSA and Pseudomonas, are rarely contaminants, similar to Candida and various fungal species.
Further, SAH/IVH patients may develop a sterile inflammatory response that causes...
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