The Organisms and Factors Affecting Outcomes of External Ventricular Drainage Catheter-Related Ventriculitis: A Penang Experience.

INTRODUCTION

Ventriculostomy-related infection (VRI) from external ventricular drain (EVD) insertion is a common complication and carries a high mortality rate. Choice of empiric antibiotics depends on the institutions common causative organisms and their susceptibility. We determined risk factors for mortality in patients with VRI, the common organisms causing VRI, and the rate of EVD-related VRI at our institution.

METHODS

Medical records and operative data of patients with cerebrospinal fluid positive cultures with an EVD inserted from 2012 to 2015 were traced. Forty-five patients with EVD-related VRI were included in the study.

RESULTS

The overall rate of VRI was 6.3%, and the overall mortality rate due to VRI was 48.9%. was the most common organism causing VRI (14 patients, 29.2%) with a mortality rate of 64.3%. Only 14.3% of are sensitive to meropenem and imipenem. We found that patients that had a decompressive craniectomy (DC) had a lower mortality rate ( = 0.042) and patients with a longer duration of the EVD being in place before the diagnosis of VRI had poor outcome ( = 0.040). Multivariate logistic regression was performed and we found that the use of steroid ( = 0.014), infection ( = 0.010), multiple organism infection ( = 0.017), lower Glasgow Coma Scale ( = 0.043), and a longer duration the EVD was in place before the diagnosis of VRI ( = 0.008) were related with higher mortality.

CONCLUSION

VRI mortality rate is high with an alarming resistance pattern seen in VRI. EVDs should be removed as soon as feasible, and DC may be offered to patients with severe ventriculitis or meningitis.