Mirza Faisal Ahmed Rafiq, Noor Ahmed, Shafqut Ali, Muhammad Naseem Khan, Khaleeq -uz- Zaman


Background: External ventricular (EVD) is a life saving procedure and involves insertion of a catheter
in ventricular space to drain cerebrospinal fluid (CSF). Our objective of this study was to determine the
culture and sensitivity (C/S) pattern in patients with EVD infection. Methods: This cross sectional study
was conducted in Department of Neurosurgery, Pakistan Institute of Medical Sciences (PIMS),
Islamabad from December 1, 2008 to January 31, 2010. All admitted patients who had acute
hydrocephalus, underwent EVD insertion after excluding meningitis and ventriculitis by physical
examination and per operative CSF sampling. The EVD was done at right Kocher’s point. Prophylactic
third generation antibiotic (Ceftriaxone) was started and continued till EVD was in place. C/S was sent to
PIMS laboratory on first documented fever and or change of CSF color or when plan was to replace
EVD with Ventriculo-peritoneal shunt (VP). Once infection was there CSF was sent for C/S initially and
routine examination (R/E) daily. Antibiotics were changed according to C/S report and continued till
they were needed. Infection rate was also estimated. Results: Among 76 patients 41 (53.9%) were male
and 35 (46.1%) were females. Most were adults and were between 31 to 40 years of age. Mean duration
of EVD was 11.41 days. Overall infection rate was 11.8%. Among causative organisms Staphylococcus
Aureus (44.4%) was most common followed by Acenitobacter and Enterobacter and commonly used
prophylactic antibiotic (Ceftriaxone) had considerable resistance. Conclusion: EVD is a simple and life
saving procedure. Most common organisms causing infection are Staphylococcus Aureus followed by
Acenitobacter. Conventional used antibiotic Ceftriaxone has considerable resistance.
Keywords: External Ventricular Drain, organisms, antibiotics

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