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61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010
Joint Meeting mit der Brasilianischen Gesellschaft für Neurochirurgie am 20. September 2010

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21. - 25.09.2010, Mannheim

A retrospective study on the infection rate of external ventricular drainage systems in patients with acute posthemorrhagic communicating hydrocephalus

Meeting Abstract

  • Florian Wrage - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Carl-Gustav-Carus, Technische Universität Dresden, Deutschland
  • Kerim-Hakan Sitoci - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Carl-Gustav-Carus, Technische Universität Dresden, Deutschland
  • Tareq Juratli - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Carl-Gustav-Carus, Technische Universität Dresden, Deutschland
  • Gabriele Schackert - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Carl-Gustav-Carus, Technische Universität Dresden, Deutschland
  • Matthias Kirsch - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Carl-Gustav-Carus, Technische Universität Dresden, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP1773

DOI: 10.3205/10dgnc244, URN: urn:nbn:de:0183-10dgnc2448

Veröffentlicht: 16. September 2010

© 2010 Wrage et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

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Objective: Morbidity associated with subarachnoid hemorrhage (SAH) is largely due to three pathomechanisms. One mechanism is the acute bleeding with destruction of CNS tissue, the second is secondary vasospasm, and the third, communicating malresorptive hydrocephalus. Therefore, the most frequent surgical procedure for SAH is ventriculostomy which can be used both for drainage and ICP measurements. The purpose of our study was to retrospectively assess the ventriculostomy-related infections.

Methods: Of all patients (pts.) suffering a SAH in our institution between Jan-2003 to Dec-2009, 333 patients 1238 pts. underwent an external ventriculostomy. In the same period, 465 additional EVDs were performed for other indications and served as a control population. Demographic data, comorbidities, medical complications, procedure-related data and the microbiology, hematologic and CSF laboratory values were assessed. Ventriculitis was defined as at least twice positive bacteriological cultures. In comparison, contamination was defined as a single positive culture.

Results: An EVD-related infection and a contamination were each seen in each 7 of 333 pts, (2.2%). Compared to all other EVDs due to different indications, the infection rate in SAH pts. was not significant (2.3% vs. 4.5%). Due to subarachnoid blood, EVD changes were necessary in 99 pts. This did not, though, add significantly to the infection rate. A permanent shunt implantation was necessary in 208 of 333 pts. Among the pts. with infections/contaminations, 12 of 14 required shunting. 197 pts. underwent a craniotomy for clipping or decompression, 153 underwent a coiling procedure. As for EVD changes, an additional craniotomy did not significantly increase the risk for infection. However, the duration of external drainage correlated significantly with infections, but not with contaminations. Of the 7 infected cases, 4 had a pneumonia, 3 vasospasm, 3 hypertension displaying a 2–3 fold frequency compared to all SAH-related ventriculostomies. The most frequent bacteria were various strains of staphylococci.

Conclusions: EVD-related infections in SAH are lower compared to other indications. A high association existed with concomitant pneumonia, vasospasms and hypertension. Among all surgical factors, only the duration of external ventricular drainage was associated with increased infection rate.