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Journal of Neurosurgical Sciences 1999 June;43(2):125-33

language: English

Infec­tions ­and re-in­fec­tions in ­long-­term exter­nal ven­tric­u­lar drain­age. A vari­a­tion ­upon a ­theme

Zingale A., Ippolito S., Pappalardo P., Chibbaro S., Amoroso R.

Division of Neurosurgery, Azien­da Osped­a­lie­ra di ­ARSN, “Gar­i­bal­di, S. Lui­gi - S. ­Currò, Asco­li-Tom­a­sel­li” , Hospitals, University of Catania, Ita­ly


Back­ground. ­The infec­tion of ­the exter­nal ven­tric­u­lar drain­age (­EDV) ­remains ­the ­main mor­bid­ity ­and mor­tal­ity asso­ciat­ed ­with ­this pro­ce­dure, in ­the set­ting of ­the treat­ment of hydro­ceph­a­lus ­and ­its com­pli­ca­tions, lead­ing to ­excess of hos­pi­tal­iza­tion ­with annu­al eco­nom­ic bur­den.
Meth­ods. In ­this 3-­year ret­ro­spec­tive ­study we select­ed ­and ­reviewed ­the ­records of 15 of 143 ­patients (­mean ­age 34 ­years ­with ­range ­from 1 ­months to 70 ­years; 12 ­males ­and 3 ­females) under­gone to pro­longed ­EVD in ­the set­ting of man­age­ment of hydro­ceph­a­lus (5 pati­ens ­because of ­acute ven­tric­u­lar dila­tion ­post-intra­ven­tric­u­lar hem­or­rhage or ­post-hemor­rhag­ic ­HCP, 8 ­because of V-P ­shunt infec­tion, 1 ­because of ­post-trau­mat­ic ­HCP ­and 1 ­because of ­shunt mal­func­tion by ele­vat­ed ­CSF pro­tein) ­and devel­op­ing a ­shunt infec­tion or ­one or ­more super­in­fec­tion.
­Results. ­There ­was a 26% mor­tal­ity ­and a 13% mor­bid­ity (1 ­patient ­had ­GOS ­score of 2, 1 ­score of 3 ­and 3 ­score of 5). ­The patho­gens yeld­ed by ­CSF cul­ture ­were nor­mal or tran­sient flo­ra of ­the ­patient’s ­skin. ­The caus­es of ınfec­tion ­were care­ful­ly anal­ized.
Con­clu­sions. ­Based on ­our expe­ri­ence ­the manag­ment of infec­tion in ­long-­term ­EVD ­includes: ­the stan­dard­iza­tion of ­the envi­ron­ment of ­the sur­gery ­achieved ­with a) ­use of pro­phy­lac­tic anti­bi­o­tics; b) prep­ar­a­tion of ­the ­patient ­and ster­ile ­field; c) no ­touch tech­nique. ­After inplan­ta­tion of ­EVD ­the ­risk of infec­tion ­must be min­i­mized by care­ful­ly nurs­ing ­care of ­EVD, ­and admin­is­tra­tion of ­above pro­phy­lac­tic anti­bi­o­tics. ­CSF ­must be col­lect­ed ­for cul­ture ­and ­cell ­count, glu­cose ­and pro­tein ­when clin­i­cal­ly indi­cat­ed. ­When infec­tion o re-infec­tion is demon­s­trat­ed by ­CSF cul­ture ­then it is advis­able to ­remove ­the ­entire hard­ware ­and ­start ­the anti­bi­o­tic ther­a­py intra­ve­nous­ly ­and intra­ven­tric­u­lar­ly bas­ing on sus­cep­ti­bil­ity ­tests, ­CSF pen­e­tra­tion of anti­bi­o­tics, ­their bac­te­ri­ci­dal ­action, tox­ic­ity, spec­i­fic­ity ­and ­cost. ­Regard to ­the dura­tion of ­the ther­a­py, a prac­ti­cal ­guide is treat­ing ­for 10-14 ­days ­after ­three con­sec­u­tive ­CSF ster­ile cul­tures. ­Thus, con­ven­tion of ­EVD to a ­shunt ­can be per­formed with­in 3 ­weeks ­from admis­sion, in ­the ­best favour­able cas­es, decreas­ing ­the dura­tion of hos­pi­tal ­stay ­and ­the over­all ­cost of neu­ro­sur­gi­cal manage­ment of ­the cere­bral pathol­o­gy requir­ing as ther­a­peu­tic ­adjunct ­and ­EVD.

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