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Comparing External Ventricular Drains-Related Ventriculitis Surveillance Definitions

Published online by Cambridge University Press:  21 February 2017

Maria M. Reyes ,
Satish Munigala ,
Emily L. Church ,
Tobias B. Kulik ,
Salah G. Keyrouz ,
Gregory J. Zipfel  and
David K. Warren
Maria M. Reyes*
Affiliation:
Department of Medicine Washington University School of Medicine, St. Louis, Missouri
Satish Munigala
Affiliation:
Department of Medicine Washington University School of Medicine, St. Louis, Missouri
Emily L. Church
Affiliation:
Department of Hospital Epidemiology and Infection Prevention, Barnes Jewish Hospital, St. Louis, Missouri
Tobias B. Kulik
Affiliation:
Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
Salah G. Keyrouz
Affiliation:
Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
Gregory J. Zipfel
Affiliation:
Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
David K. Warren
Affiliation:
Department of Medicine Washington University School of Medicine, St. Louis, Missouri
*
Address correspondence to Maria Reyes, MD, 7777 Hennessy Blvd, Ste 7000, Baton Rouge, LA 70808 (Mariareyesa@gmail.com).
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Abstract

OBJECTIVE

To evaluate the agreement between the current National Healthcare Safety Network (NHSN) definition for ventriculitis and others found in the literature among patients with an external ventricular drain (EVD)

DESIGN

Retrospective cohort study from January 2009 to December 2014

SETTING

Neurology and neurosurgery intensive care unit of a large tertiary-care center

PATIENTS

Patients with an EVD were included. Patients with an infection prior to EVD placement or a permanent ventricular shunt were excluded.

METHODS

We reviewed the charts of patients with positive cerebrospinal fluid (CSF) cultures and/or abnormal CSF results while they had an EVD in place and applied various ventriculitis definitions.

RESULTS

We identified 48 patients with a total of 52 cases of ventriculitis (41 CSF culture-positive cases and 11 cases based on abnormal CSF test results) using the NHSN definition. The most common organisms causing ventriculitis were gram-positive commensals (79.2%); however, 45% showed growth of only 1 colony on 1 piece of media. Approximately 60% of the ventriculitis cases by the NHSN definition met the Honda criteria, approximately 56% met the Gozal criteria, and 23% met Citerio’s definition. Cases defined using Honda versus Gozal definitions had a moderate agreement (κ=0.528; P<.05) whereas comparisons of Honda versus Citerio definitions (κ=0.338; P<.05) and Citerio versus Gozal definitions (κ=0.384; P<.05) had only fair agreements.

CONCLUSIONS

The agreement between published ventriculostomy-associated infection (VAI) definitions in this cohort was moderate to fair. A VAI surveillance definition that better defines contaminants is needed for more homogenous application of surveillance definitions between institutions and better comparison of rates.

Infect Control Hosp Epidemiol 2017;38:574–579

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 5 , May 2017 , pp. 574 - 579
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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