Clinical and Laboratory Characteristics for the Diagnosis of Bacterial Ventriculitis After Aneurysmal Subarachnoid Hemorrhage

• Published in: Neurocritical care 2017-06, Vol.26 (3), p.362-370
• Main Authors: Hoogmoed, J., van de Beek, D., Coert, B. A., Horn, J., Vandertop, W. P., Verbaan, D.
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - therapeutic use; Antibiotics; Catheters; Central Nervous System Bacterial Infections - cerebrospinal fluid; Central Nervous System Bacterial Infections - drug therapy; Central Nervous System Bacterial Infections - etiology; Cerebral Ventriculitis - cerebrospinal fluid; Cerebral Ventriculitis - drug therapy; Cerebral Ventriculitis - etiology; Cerebrospinal fluid; Cerebrospinal Fluid Shunts - adverse effects; Critical Care Medicine; Cross Infection - cerebrospinal fluid; Cross Infection - drug therapy; Cross Infection - etiology; Female; Glucose; Hematoma; Hemorrhage; Humans; Infections; Intensive; Internal Medicine; Intracranial Aneurysm - complications; Leukocytes; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Mortality; Neurology; Original; Original Article; Patients; Proteins; Retrospective Studies; Subarachnoid Hemorrhage - surgery; Variables
• ISSN: 1541-6933; 1556-0961
• DOI: 10.1007/s12028-016-0345-8

Background The diagnosis of nosocomial bacterial ventriculitis in patients with subarachnoid hemorrhage (SAH) can be challenging. Methods We performed a retrospective study on the diagnostic accuracy of clinical and laboratory characteristics for the diagnosis of bacterial ventriculitis in 209 consecutive patients with an aneurysmal SAH admitted in a tertiary referral center from 2008 to 2010. Diagnostic value of clinical characteristics and inflammatory indexes in CSF and blood were determined for three diagnostic categories: (1) no suspicion for bacterial ventriculitis; (2) clinical suspicion for bacterial ventriculitis, defined as initiation of empirical antibiotic treatment for ventriculitis, but negative CSF cultures; and (3) CSF culture-positive bacterial ventriculitis. Results Empirical antibiotics for suspected ventriculitis was initiated in 48 of 209 (23 %) patients. CSF cultures were positive in 11 (5 %) patients. Within the group of suspected ventriculitis, only longer duration of CSF drainage and lower CSF red blood cell counts predicted for culture positivity. None of the other clinical features or inflammatory indexes in CSF and blood were associated with culture-proven bacterial ventriculitis. Conclusions Nosocomial bacterial ventriculitis in patients with aneurysmal SAH is often suspected but confirmed by culture in a minority of cases. Improvement of diagnostics for nosocomial bacterial ventriculitis in patients with aneurysmal SAH is needed.