1Department of Health Science, University of Milano-Bicocca, Monza, Italy. 2Neurointensive Care, Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy. 3Department of Infectious and Tropical Diseases, Spedali Civili Hospital, Brescia, Italy. 4Department of Epidemiology, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy. 5Department of Anesthesia, Critical Care and Emergency, Spedali Civili Hospital, Brescia, Italy. 6Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
Crit Care Med. 2015 Aug;43(8):1630-7. doi: 10.1097/CCM.0000000000001019.
Use of external ventricular drains and lumbar catheters is associated with a risk of ventriculitis and meningitis ranging from 2% to 24% because of lack of standardized diagnostic criteria. We evaluated the prevalence of ventriculitis or meningitis in 13 Italian ICUs.
Multicenter, prospective study.
Thirteen Italian ICUs.
Two hundred seventy-one patients (mean age, 57 yr) receiving a total number of 311 catheters. Two hundred fifty patients (92.2%) had an external ventricular drain, 17 patients (6.3%) had a lumbar catheter, and four patients (1.5%) had both external ventricular drain and lumbar catheter.
ICUs enrolled at least 10 consecutive adult patients with an external ventricular drain or lumbar catheter in place for more than 24 hours. Confirmed cerebrospinal fluid infection was defined by presence of a positive cerebrospinal fluid culture, a cerebrospinal fluid/blood glucose ratio less than 0.5, a neutrophilic cerebrospinal fluid pleocytosis (> 5 cells/μL), and fever. Abnormal cerebrospinal fluid findings with negative cultures were defined as suspected infection.
Median duration of device use was 13 days (interquartile range, 8-19). Fifteen patients (5.5%) had a confirmed ventriculitis or meningitis, and 15 patients (5.5%) had a suspected ventriculitis or meningitis. Cerebrospinal fluid glucose and cerebrospinal fluid/blood glucose ratio were lower in patients with confirmed ventriculitis or meningitis and suspected ventriculitis or meningitis; proteins and lactates were significantly higher in confirmed ventriculitis or meningitis. Gram-negative and Gram-positive bacteria were equally cultured. Risk factors for infection were a concomitant extracranial infection (odds ratio, 2.34; 95% CI, 1.01-5.40; p = 0.05) and placement of catheters outside the operation room (odds ratio, 4.01; 95% CI, 0.98-16.50; p = 0.05).
Ventriculitis or meningitis remains a problem in Italian ICUs, and a strategy for reducing the prevalence is worth planning.
由于缺乏标准化的诊断标准，使用外部脑室引流管和腰椎导管与 2%至 24%的脑室炎和脑膜炎风险相关。我们评估了 13 家意大利 ICU 中脑室炎或脑膜炎的患病率。
多中心前瞻性研究。
13 家意大利 ICU。
271 名（平均年龄 57 岁）患者，共使用 311 根导管。250 名患者（92.2%）有外部脑室引流管，17 名患者（6.3%）有腰椎导管，4 名患者（1.5%）有外部脑室引流管和腰椎导管。
每家 ICU 至少纳入 10 例连续的成年患者，这些患者有外部脑室引流管或腰椎导管留置超过 24 小时。确认的脑脊液感染定义为脑脊液培养阳性、脑脊液/血糖比值<0.5、中性粒细胞性脑脊液白细胞增多（>5 个/μL）和发热。异常脑脊液发现但培养阴性定义为疑似感染。
设备使用的中位数时间为 13 天（四分位距，8-19）。15 名患者（5.5%）患有确诊的脑室炎或脑膜炎，15 名患者（5.5%）患有疑似脑室炎或脑膜炎。确诊的脑室炎或脑膜炎和疑似脑室炎或脑膜炎患者的脑脊液葡萄糖和脑脊液/血糖比值较低；蛋白质和乳酸水平在确诊的脑室炎或脑膜炎患者中显著升高。革兰氏阴性和革兰氏阳性细菌的培养结果相同。感染的危险因素是同时存在颅外感染（比值比，2.34；95%可信区间，1.01-5.40；p=0.05）和导管在手术室外放置（比值比，4.01；95%可信区间，0.98-16.50；p=0.05）。
脑室炎或脑膜炎在意大利 ICU 中仍然是一个问题，值得制定降低其患病率的策略。
