Brief reportCerebrospinal fluid drainage-related ventriculitis due to multidrug-resistant microorganismsVentriculitis asociadas a dispositivos de drenaje de líquido cefalorraquídeo causadas por microorganismos multirresistentes
Introduction
Cerebrospinal fluid (CSF) drainage devices are used for multiple clinical conditions.1 Infection is the major complication of these devices, and is associated with high morbidity and mortality.2, 3 The reported incidence of shunt infection is 4%–17%.2, 3 In regard to external ventricular drainages (EVD), a pooled incidence of 10.6–11.4 per 1000 catheter-days was observed in a large metanalysis.3
Symptoms of infection are very heterogeneous and depend on the type of device and pathogen virulence.2, 4 The most frequently isolated microorganisms are Gram-positive pathogens, especially Staphylococcus epidermidis.1, 2, 3, 4, 5 However, in recent years there has been an increase in infections due to multidrug-resistant Gram-negative bacilli6, 7 and Candida spp.2, 8
Although conservative management may be appropriate for selected patients,5 complete device removal in combination with targeted antibiotic therapy have been associated with improved clinical outcome,2, 4, 9 and thus it is the current recommendation.1
Most of the published series on infection of CSF derivation devices collected data in pediatric patients, whereas available data in adults is scarce.4, 9, 10, 11, 12 The objective of this study was to analyze the characteristics of CSF derivation device infections, management and clinical evolution in adult patients.
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Methods
The Complexo Hospitalario Universitario de Vigo (Spain) is a tertiary hospital with 1250 beds and is the reference center for Neurosurgery serving an area of more than 700,000 inhabitants. All positive CSF cultures obtained between January 2010 and June 2019 were retrospectively reviewed. We included all patients aged ≥18 years with any type of CSF drainage infection.
Case definition: CSF drainage device infection was considered for all patients with positive CSF cultures and at least one of the
Results
In our center, 844 CSF drainage devices were placed during the study period; of these, 631 were external drainages and 213 shunts. Ninety-one episodes of CSF drainage device infection were identified in 74 patients: 70 episodes involved external drainages (2 lumbar and 68 ventricular drainages) and 21 episodes occurred in shunts (18 ventriculo-peritoneal and 3 ventriculo-atrial). The majority of patients were male (57%), with a median age of 64 years (IQR, 49–72 years). External device-related
Discussion
Our study represents, to our knowledge, the largest series of CSF drainage-related ventriculitis in adults. In our series, we found a high prevalence of multidrug-resistant organisms, not only carbapenem-resistant Gram-negative bacilli, but also linezolid-resistant S. epidermidis.
The recent worldwide emergence of linezolid-resistant staphylococci raises significant challenges for the treatment of infections caused by these microorganisms.14, 15 Mutations at the ribosomal target site (23S rRNA)
Funding
No.
Conflict of interest
The authors declare that they have no conflict of interest.
Acknowledgements
The authors wish to thank to Manuel Crespo, Cesareo Conde and Adrián Sousa their support to carry out this work.
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