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

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...


  1. 1.
    Gozal YM, Farley CW, Hanseman DJ, et al. Ventriculostomy-associated infection: a new, standardized reporting definition and institutional experience. Neurocrit Care. 2014;21:147–51.CrossRefGoogle Scholar
  2. 2.
    Fishman RA. Cerebrospinal fluid in diseases of the nervous system. 2nd ed. Philadelphia: W. B. Saunders Company; 1992.Google Scholar
  3. 3.
    Jackson DA, Patel AV, Darracott RM, Hanel RA, Freeman WD, Hanley DF. Safety ofintraventricularhemorrhage (IVH) thrombolysis based on CT localization of external ventricular drain (EVD) fenestrations and analysis of EVD tract hemorrhage. Neurocrit Care. 2013;19:103–10.CrossRefGoogle Scholar
  4. 4.
    Joint Commission, Comprehensive Stroke Center Pre-Publication Guidelines. Accessed 1 July 2014.
  5. 5.
    Amin BY, Tu TH, Schairer WW, et al. Pitfalls of calculating hospital readmission rates based on nonvalidated administrative data sets: presented at the 2012 Joint Spine Section Meeting: clinical article. J Neurosurg Spine. 2013;18:134–8.CrossRefGoogle Scholar
  6. 6.
    Teufack SG, Campbell P, Jabbour P, Maltenfort M, Evans J, Ratliff JK. Potential financial impact of restriction in “never event” and periprocedural hospital-acquired condition reimbursement at a tertiary neurosurgical center: a single-institution prospective study. J Neurosurg. 2010;112:249–56.CrossRefGoogle Scholar
  7. 7.
    Klompas M. Does this patient have ventilator-associated pneumonia? JAMA. 2007;297:1583–93.CrossRefGoogle Scholar
  8. 8.
    Kuusinen P, Ala-Kokko T, Jartti A, et al. The occurrence of pneumonia diagnosis among neurosurgical patients: the definition matters. Neurocrit Care. 2012;16:123–9.CrossRefGoogle Scholar
  9. 9.
    Nussenblatt V, Avdic E, Berenholtz S, et al. Ventilator-associated pneumonia: inappropriate diagnosis and treatment is common in medical and surgical intensive care units. Infect Control Hosp Epidemiol. 2014;35:278–84.CrossRefGoogle Scholar
  10. 10.
    Hanley D, Johns Hopkins University, National Institute of Neurological Disorders and Stroke, Genentech, Emissary International LLC. Clot Lysis: evaluating accelerated resolution of intraventricular hemorrhage phase III (CLEAR III trial). In: [Internet]. Bethesda, (MD): National Library of Medicine (US). 2014. Available from: Accessed 21 July 2014.
  11. 11.
    Ziai W, McBee N, Butcher K, et al. Safety endpoints and thromboembolic events for the first 250 patients enrolled in the Clot Lysis: evaluation of accelerated resolution of intraventricular hemorrhage trial (CLEAR III). Presented at the 2014 International Stroke Conference (ISC), American Heart Association, San Diego. Available at: Accessed 22 July 2014.

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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