CULTURE AND SENSITIVITY PATTERN IN PATIENTS WITH EXTERNAL VENTRICULAR DRAIN INFECTION
AbstractBackground: External ventricular (EVD) is a life saving procedure and involves insertion of a catheterin ventricular space to drain cerebrospinal fluid (CSF). Our objective of this study was to determine theculture and sensitivity (C/S) pattern in patients with EVD infection. Methods: This cross sectional studywas 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 acutehydrocephalus, underwent EVD insertion after excluding meningitis and ventriculitis by physicalexamination and per operative CSF sampling. The EVD was done at right Kocher’s point. Prophylacticthird generation antibiotic (Ceftriaxone) was started and continued till EVD was in place. C/S was sent toPIMS laboratory on first documented fever and or change of CSF color or when plan was to replaceEVD with Ventriculo-peritoneal shunt (VP). Once infection was there CSF was sent for C/S initially androutine examination (R/E) daily. Antibiotics were changed according to C/S report and continued tillthey were needed. Infection rate was also estimated. Results: Among 76 patients 41 (53.9%) were maleand 35 (46.1%) were females. Most were adults and were between 31 to 40 years of age. Mean durationof EVD was 11.41 days. Overall infection rate was 11.8%. Among causative organisms StaphylococcusAureus (44.4%) was most common followed by Acenitobacter and Enterobacter and commonly usedprophylactic antibiotic (Ceftriaxone) had considerable resistance. Conclusion: EVD is a simple and lifesaving procedure. Most common organisms causing infection are Staphylococcus Aureus followed byAcenitobacter. Conventional used antibiotic Ceftriaxone has considerable resistance.Keywords: External Ventricular Drain, organisms, antibiotics
Korinek AM, Reina M, Boch AL, Rivera AO, De Bels D,
Puybasset L. Prevention of external ventricular drain-related
ventriculitis. Acta Neurochir (Wien) 2008;150:209–14.
Zabramski JM, Whiting D, Darouiche RO, Horner TG, Olson J,
Robertson C et al. Efficacy of antimicrobial-impregnated
external ventricular drain catheters: a prospective, randomized,
controlled trial. J Neurosurg 2003;98:725–30.
Lo CH, Spelman D, Bailey M, Cooper DJ, Rosenfeld JV,
Bercknell JE. External ventricular drain infections are
independent of drain duration: an argument against elective
revision. J Neurosurg 2007;106:378–83.
Aucoin PJ, Kotilainen HR, Gantz NM, Davidson R, Kellogg P,
Stone B. Intracranial pressure monitors. Epidemiologic study of
risk factors and infections. Am J Med 1986;80:369–76.
Nava-Ocampo AA, Mojica-Madera JA, Villanueva-Garcia D,
Caltenco-Serrano R. Antimicrobial therapy and local toxicity of
intraventricular administration of Vancomycin in a neonate with
ventriculitis. Ther Drug Monit 2006;28:474–80.
Eddy VA, Vitsky JL, Rutherford EJ, Morris JA Jr. Aggressive
use of ICP monitoring is safe and alters patient care. AM Surg
Beer R, Lackner P, Pfausler B, Schmutzhard E. Nosocomial
ventriculitis and meningitis in neurocritical care patients. J Neurol
Prabhu VC, Kaufman HH, Voelker JL, Arronoff SC,
Niewiadomska- Bugaj M, Mascaro S et al. Prophylactic
antibotics with intracranial pressure monitors and external
ventricular drains: a review of the evidence. Surg Neurol
Rebuck JA, Murry KR, Rhoney DH, Michael DB, Coplin WM,
infection related to intracranial pressure monitors in adults:
analysis of risk factors and antibiotic prophylaxis. J Neurol
Neurosurg Psychiatry 2000:69;381–5.
Muttaiyah S, Ritchie S, Upton A, Roberts S. Clinical parameters
do not predict infection in patients with external ventricular
drains: a retrospective observational study of daily cerebrospinal
fluid analysis. J Med Microbiol 2008;57:207–16.
Kestle JR, Garton HJ, Whitehead WE, Drake JM, Kulkarni AV,
Cochrane DD et al. Management of shunt infections: a
multicentre pilot study. J Neurosurg 2006;105:177–81.
Lozier AP, Sciacca RR, Romagnoli MF, Connolly ES Jr.
Ventriculostomy related infections: a critical review of the
literature. Neurosurgery 2002;51:170–81.