gms | German Medical Science

Objective: Ventricular catheters are essential in the care of patients with elevated intracranial pressure and with acute hydrocephalus. However, ventriculostomy-related infections (VRIs) might be an infrequent but life-threatening problem in critically ill neurosurgical patients.

Methods: We retrospectively analyzed 813 patients, who underwent ventriculostomy between January 2005 and October 2008 in our department. Patients with suspected ventriculitis prior to ventriculostomy due to ventriculoperitoneal shunt infection, meningitis or other infectious entities were excluded from the study. To exclude contaminations, we defined infection as two or more positive cerebrospinal fluid cultures. Patient’s age, sex, diagnosis, duration of catheterization, catheter exchange, duration of the ICU-stay and the spectrum of microorganisms were investigated.

Results: Median age was 52 years. Subarachnoid and intracerebral haemorrhages were the most frequent indications for a ventriculostomy. Of 813 patients, 20 (2.5%) had a ventriculitis. The median duration of catheterization in patients without VRI was 11 days. Duration of catheterization among the patients with positive cultures was 23 days. The median ICU-stay was 9 days longer (p<0.05). Our current protocol relies on regular changes every 10 days and daily microbiological cultures. On average, ventriculostomy-related infections occurred at the 8th day after catheter insertion. Coagulase-negative staphylococci were the most frequent pathogenic microorganisms (75%). Intraventricular irrigation with gentamicin or vancomycin was instituted upon positive microbiological cultures.

Conclusions: Although there is no consensus about the antibiotic prophylaxis after ventriculostomies or catheter change in regular intervals, we administer periprocedural antibiotics and continue them as long as the catheter is in place. This practice along with regular scanning for contamination, as well as a long subcutaneous tunnelling distance seems to reduce the ventriculitis rate in neurosurgical patients with an external ventricular drain, since our infection rate is low compared to other studies.