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JOURNAL OF NEUROSURGICAL SCIENCES
Rivista di Neurochirurgia
Indexed/Abstracted in: e-psyche, EMBASE, PubMed/MEDLINE, Neuroscience Citation Index, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,651
Journal of Neurosurgical Sciences 1999 Giugno;43(2):125-33
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.