Ventriculostomy-related Infections in the Neurosurgical Intensive Care Unit: The Risk Factors and the Outcomes

Abstract

Background: This study was performed to analyze the risk factors for ventriculostomy-related infections (VRIs) in the neurosurgical intensive care unit (NSICU) and the relationship between these risk factors and the patients' outcomes. Methods: We collected demographic, clinical, laboratory and microbiological data from all 146 consecutive adult patients who underwent ventriculostomy in the NSICU from January 2007 to December 2008. We excluded patients with ventriculostomy performed for the draining of intraventricular abscess, infection of ventriculoperitoneal shunt (V-P shunt) or previous ventriculitis. VRI was defined by positive culture from cerebrospinal fluid (CSF) obtained via the ventricular catheter. Results: VRIs were diagnosed in 26 (17.8%) of 146 patients. On average, the patients with VRIs stayed longer in the NSICU than patients without VRIs (mean duration 20 days vs. 11.9 days). All VRIs occurred in patients who had a low Acute Physiology and Chronic Health Evaluation (APACHE) IV score. In addition, the duration required to maintain ventriculostomy was longer in patients with VRIs. However, sex, mortality, the cause of ven-triculosotmy, the level of consciousness, combined systemic infections, number of catheters, and performing ur-okinase irrigation or antibiotics irrigation via the ventriculostomy catheter were not associated with VRIs. Conclusions: VRIs were associated with longer ICU stay. However, VRIs did not influence the overall mortality rate of patients undergoing ventriculostomy in the NSICU. Because the long duration required for maintaining ven-triculostomy was the risk factor of VRI, early removal of ventriculostomy catheter must be considered.