Department of Neurosurgery, University of Cincinnati College of Medicine, ML 0515, Cincinnati, OH, 45267-0515, USA.
Neurocrit Care. 2014 Aug;21(1):147-51. doi: 10.1007/s12028-013-9936-9.
Shortcomings created by the lack of both a uniform definition of ventriculostomy-associated infection (VAI) and reporting standards have led to widely ranging infections rates (2-24%) whose significance is uncertain. We propose a standardized definition of VAI and a consistent reporting format compliant with Centers for Disease Control and Prevention (CDC) for device-related infections. Using those parameters to establish an infection-control surveillance program, we report our 4-year institutional VAI rates.
In this prospective study covering ventriculostomy utilization (October 2006-December 2010), 498 patients had a total of 4,673 ventriculostomy days. By review of the literature and our institutional analysis, we defined VAI as a positive CSF culture in a patient with ventriculostomy catheter, plus one or more of the following (1) fever recorded >101.5 °F or (2) cerebrospinal fluid (CSF) glucose level, either <50 mg/dL or <50% of a serum glucose level drawn within 24 h of the CSF glucose. In a report format that is CDC compliant, rates of VAI are reported.
Among our patients, the CDC-compliant infection rate was 2.14 per 1,000 ventriculostomy days. Of the 10 VAIs occurring in 498 patients during 4,673 ventriculostomy days, this 2.0% infection rate was lower than the previously reported 8.8% composite rates of VAI. Average duration of ventriculostomy was 9.4 days. Neither antibiotic-impregnated catheters nor periprocedural or prophylactic antibiotics were used.
Our standardized VAI definition and CDC format seems promising toward facilitating future study and guideline development. Given our strict protocol of sterile catheter placement and care, and our institution's low 2.0% infection rates, we propose an infection-rate target of ≤5 per 1,000 device days. Our results suggest that the use of antibiotics or antibiotic-impregnated catheters is unwarranted--a positive given concerns of evolving anti-microbial resistance.
由于缺乏统一的脑室切开术相关感染 (VAI) 定义和报告标准，导致感染率差异很大（2-24%），但其意义尚不确定。我们提出了一种标准化的 VAI 定义和符合疾病预防控制中心 (CDC) 的设备相关感染报告格式。使用这些参数建立感染控制监测计划，我们报告了我们机构 4 年来的 VAI 发生率。
在这项涵盖脑室切开术使用的前瞻性研究中（2006 年 10 月至 2010 年 12 月），498 名患者共有 4673 天的脑室切开术。通过文献回顾和我们机构的分析，我们将 VAI 定义为脑室切开术导管患者的脑脊液培养阳性，加上以下一种或多种情况：(1) 记录的体温>101.5°F；或 (2) 脑脊液 (CSF) 葡萄糖水平<50mg/dL 或<24 小时内 CSF 葡萄糖与血清葡萄糖水平之比<50%。我们采用符合 CDC 报告格式的方法报告 VAI 发生率。
在我们的患者中，符合 CDC 标准的感染率为每 1000 个脑室切开术天 2.14 例。在 498 名患者的 4673 天脑室切开术期间发生的 10 例 VAI 中，这 2.0%的感染率低于之前报告的 8.8%的 VAI 综合发生率。脑室切开术的平均持续时间为 9.4 天。未使用抗生素浸渍导管或围手术期或预防性抗生素。
我们的标准化 VAI 定义和 CDC 格式似乎有望促进未来的研究和指南制定。考虑到我们严格的无菌导管放置和护理方案，以及我们机构 2.0%的低感染率，我们建议将感染率目标定为<5/1000 设备天。我们的结果表明，使用抗生素或抗生素浸渍导管是不必要的——鉴于对抗微生物耐药性不断演变的担忧，这是一个积极的结果。
