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From the Skin to the Brain: Pathophysiology of Colonization and Infection of External Ventricular Drain, a Prospective Observational Study.

Mounier R, Lobo D, Cook F, Martin M, Attias A, Aït-Mamar B, Gabriel I, Bekaert O, Bardon J, Nebbad B, Plaud B, Dhonneur G - PLoS ONE (2015)

Bottom Line: Sixteen positive events were diagnosed; a cutaneous origin was identified in 69% of cases.The presence of a pathogen at skin site (6/16 vs 4/85, OR: 11.8, [2.5-56.8], p = 0.002) and CSF leakage (7/16 vs 6/85, OR 10 [2.4-41.2], p = 0.001)) were the two independent significant risk factors statistically linked to positive events occurrence.Our results suggest that VRC and VRI mainly results from an extra-luminal progression of pathogens initially colonizing the skin site where CSF leaks.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesia and Surgical Intensive Care, Henri Mondor University Hospital of Paris, Paris XII school of medicine, Créteil, France.

ABSTRACT
Ventriculostomy-related infection (VRI) is a serious complication of external ventricular drain (EVD) but its natural history is poorly studied. We prospectively tracked the bacteria pathways from skin towards ventricles to identify the infectious process resulting in ventriculostomy-related colonization (VRC), and VRI. We systematically sampled cerebrospinal fluid (CSF) on a daily basis and collected swabs from both the skin and stopcock every 3.0 days for microbiological analysis including in 101 neurosurgical patient. Risk factors for positive event defined as either VRC or VRI were recorded and related to our microbiological findings. A total of 1261 CSF samples, 473 skin swabs, and 450 stopcock swabs were collected. Skin site was more frequently colonized than stopcock (70 (60%) vs 34 (29%), p = 0.023), and earlier (14 ±1.4 vs 24 ±1.5 days, p<0.0001). Sixty-one (52%) and 32 (27%) skin and stopcock sites were colonized with commensal bacteria, 1 (1%) and 1 (1%) with pathogens, 8 (7%) and 1 (1%) with combined pathogens and commensal bacteria, respectively. Sixteen positive events were diagnosed; a cutaneous origin was identified in 69% of cases. The presence of a pathogen at skin site (6/16 vs 4/85, OR: 11.8, [2.5-56.8], p = 0.002) and CSF leakage (7/16 vs 6/85, OR 10 [2.4-41.2], p = 0.001)) were the two independent significant risk factors statistically linked to positive events occurrence. Our results suggest that VRC and VRI mainly results from an extra-luminal progression of pathogens initially colonizing the skin site where CSF leaks.

No MeSH data available.


Related in: MedlinePlus

Flow Chart of the patients.132 patients older than 18 year-old received external ventricular drainage for at least 48 hours. From September 2009 to February 2011, 101 patients were included.
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pone.0142320.g001: Flow Chart of the patients.132 patients older than 18 year-old received external ventricular drainage for at least 48 hours. From September 2009 to February 2011, 101 patients were included.

Mentions: During the study period 101 patients that underwent placement of 116 EVDs were included (Fig 1). Population and EVD placement characteristics are shown in Table 1.


From the Skin to the Brain: Pathophysiology of Colonization and Infection of External Ventricular Drain, a Prospective Observational Study.

Mounier R, Lobo D, Cook F, Martin M, Attias A, Aït-Mamar B, Gabriel I, Bekaert O, Bardon J, Nebbad B, Plaud B, Dhonneur G - PLoS ONE (2015)

Flow Chart of the patients.132 patients older than 18 year-old received external ventricular drainage for at least 48 hours. From September 2009 to February 2011, 101 patients were included.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4640851&req=5

pone.0142320.g001: Flow Chart of the patients.132 patients older than 18 year-old received external ventricular drainage for at least 48 hours. From September 2009 to February 2011, 101 patients were included.
Mentions: During the study period 101 patients that underwent placement of 116 EVDs were included (Fig 1). Population and EVD placement characteristics are shown in Table 1.

Bottom Line: Sixteen positive events were diagnosed; a cutaneous origin was identified in 69% of cases.The presence of a pathogen at skin site (6/16 vs 4/85, OR: 11.8, [2.5-56.8], p = 0.002) and CSF leakage (7/16 vs 6/85, OR 10 [2.4-41.2], p = 0.001)) were the two independent significant risk factors statistically linked to positive events occurrence.Our results suggest that VRC and VRI mainly results from an extra-luminal progression of pathogens initially colonizing the skin site where CSF leaks.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesia and Surgical Intensive Care, Henri Mondor University Hospital of Paris, Paris XII school of medicine, Créteil, France.

ABSTRACT
Ventriculostomy-related infection (VRI) is a serious complication of external ventricular drain (EVD) but its natural history is poorly studied. We prospectively tracked the bacteria pathways from skin towards ventricles to identify the infectious process resulting in ventriculostomy-related colonization (VRC), and VRI. We systematically sampled cerebrospinal fluid (CSF) on a daily basis and collected swabs from both the skin and stopcock every 3.0 days for microbiological analysis including in 101 neurosurgical patient. Risk factors for positive event defined as either VRC or VRI were recorded and related to our microbiological findings. A total of 1261 CSF samples, 473 skin swabs, and 450 stopcock swabs were collected. Skin site was more frequently colonized than stopcock (70 (60%) vs 34 (29%), p = 0.023), and earlier (14 ±1.4 vs 24 ±1.5 days, p<0.0001). Sixty-one (52%) and 32 (27%) skin and stopcock sites were colonized with commensal bacteria, 1 (1%) and 1 (1%) with pathogens, 8 (7%) and 1 (1%) with combined pathogens and commensal bacteria, respectively. Sixteen positive events were diagnosed; a cutaneous origin was identified in 69% of cases. The presence of a pathogen at skin site (6/16 vs 4/85, OR: 11.8, [2.5-56.8], p = 0.002) and CSF leakage (7/16 vs 6/85, OR 10 [2.4-41.2], p = 0.001)) were the two independent significant risk factors statistically linked to positive events occurrence. Our results suggest that VRC and VRI mainly results from an extra-luminal progression of pathogens initially colonizing the skin site where CSF leaks.

No MeSH data available.


Related in: MedlinePlus