Bota Daliana Peres, Lefranc Florence, Vilallobos Hector Rodriguez, Brimioulle Serge, Vincent Jean-Louis
Department of Intensive Care, Erasme Hospital, Free University of Brussels, Belgium.
J Neurosurg. 2005 Sep;103(3):468-72. doi: 10.3171/jns.2005.103.3.0468.
The authors undertook a study to analyze the risk factors for ventriculostomy-related infections (VRIs) in critically ill patients and their relation with outcome.
Demographic, clinical, laboratory, and microbiological data were collected from all 638 consecutive adult patients in whom an external ventriculostomy catheter was placed for monitoring during a 6-year period; patients were treated in a 31-bed intensive care unit (ICU) of a teaching hospital. Of 3726 cerebrospinal fluid (CSF) culture samples analyzed, 1348 (217 patients) showed bacterial growth; of these 97 (obtained in 58 patients [9%]) were considered to represent an infection, 106 (in 68 patients [11%]) colonization, and 145 (in 91 patients [14%]) contamination. Hence, a VRI was diagnosed in 58 (9%) of 638 patients. There were no significant differences in Acute Physiology and Chronic Health Evaluation II score, Glasgow Coma Scale score, and mortality rate, but patients with a VRI stayed longer in the ICU than those without one (p = 0.02). The duration of ventriculostomy monitoring was longer in patients with VRI (median 15 and 9 days, respectively; p = 0.02). Although the daily drained volume of CSF was higher after onset of the infection than before infection in patients with VRI (124 +/- 36 and 85 +/- 14 ml/day, respectively), the need for ventriculoperitoneal shunt placement was no more common in those with VRI than in those without (12 and 15%, respectively; p = 0.2). Multivariate logistic regression revealed that subarachnoid hemorrhage (SAH), intraventricular hemorrhage (IVH), craniotomy, and coinfection were risk factors for VRIs.
In this large series of patients, VRI was associated with a longer ICU stay, but its presence did not influence survival. A longer duration of ventriculostomy catheter monitoring in patients with VRI might be due to an increased volume of drained CSF during infection. Risk factors associated with VRIs are SAH, IVH, craniotomy, and coinfection.
作者开展一项研究，分析重症患者脑室造瘘相关感染（VRI）的危险因素及其与预后的关系。
收集了连续6年期间在一家教学医院31张床位的重症监护病房（ICU）接受治疗的638例置入外部脑室造瘘导管进行监测的成年患者的人口统计学、临床、实验室及微生物学数据。在分析的3726份脑脊液（CSF）培养样本中，1348份（217例患者）显示有细菌生长；其中97份（来自58例患者[9%]）被认为代表感染，106份（来自68例患者[11%]）为定植，145份（来自91例患者[14%]）为污染。因此，638例患者中有58例（9%）被诊断为VRI。急性生理与慢性健康状况评分系统II评分、格拉斯哥昏迷量表评分及死亡率无显著差异，但发生VRI的患者在ICU的住院时间比未发生VRI的患者更长（p = 0.02）。发生VRI的患者脑室造瘘监测时间更长（中位数分别为15天和9天；p = 0.02）。虽然发生VRI的患者感染后每日脑脊液引流量高于感染前（分别为124±36和85±14 ml/天），但VRI患者行脑室腹腔分流术的需求并不比未发生VRI的患者更常见（分别为12%和15%；p = 0.2）。多因素logistic回归显示，蛛网膜下腔出血（SAH）、脑室内出血（IVH）、开颅手术及合并感染是VRI的危险因素。
在这一大型患者系列中，VRI与ICU住院时间延长相关，但其存在并不影响生存。VRI患者脑室造瘘导管监测时间更长可能是由于感染期间脑脊液引流量增加。与VRI相关的危险因素为SAH、IVH、开颅手术及合并感染。
