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Neurocritical Care

, Volume 30, Issue 1, pp 224–225 | Cite as

Ventriculostomy-Associated Infection (VAI): In Search of a Definition

  • William D. FreemanEmail author
  • Wendy C. Ziai
  • Daniel Hanley
Letter to the Editor
  • 466 Downloads

We read with great interest the article by Gozal et al. on ventriculostomy-associated infection (VAI) [1]. 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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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • William D. Freeman
    • 1
    • 2
    • 3
    Email author
  • Wendy C. Ziai
    • 4
  • Daniel Hanley
    • 5
  1. 1.Departments of NeurologyMayo ClinicJacksonvilleUSA
  2. 2.Departments of NeurosurgeryMayo ClinicJacksonvilleUSA
  3. 3.Departments of Critical CareMayo ClinicJacksonvilleUSA
  4. 4.Department of Neurocritical CareThe Johns Hopkins HospitalBaltimoreUSA
  5. 5.Department of NeurologyThe Johns Hopkins HospitalBaltimoreUSA

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