Brief report
Cerebrospinal fluid drainage-related ventriculitis due to multidrug-resistant microorganismsVentriculitis asociadas a dispositivos de drenaje de líquido cefalorraquídeo causadas por microorganismos multirresistentes

https://doi.org/10.1016/j.eimc.2020.12.010Get rights and content

Abstract

Introduction

The aim of the study was to analyze the clinical and microbiological characteristics of adult patients with cerebrospinal fluid (CSF) drainage-related ventriculitis.

Methods

Retrospective study from January 2010 to June 2019 performed in the Complexo Hospitalario Universitario de Vigo (Spain). Cases of CSF drainage-related ventriculitis in patients ≥18-year-old were gathered. Clinical characteristics of patients, type of drainage devices, management and microbiological isolates were analyzed.

Results

Ninety-one episodes of CSF drainage-related ventriculitis were identified. The most frequent organisms isolated were Gram-positive cocci (65%), mainly Staphylococcus epidermidis (48%). Multidrug-resistant microorganisms were detected in 21 episodes (23%). In multivariate analysis, the independent factors related with multidrug-resistant ventriculitis were the length of hospital stay >14 days (HR 6.7; 95%CI 1.75–25.86, p = 0.006) and previous antimicrobial therapy (HR 5.58; 95%CI 1.44–21.65, p = 0.013).

Conclusions

Our study shows a large number of drainage-related ventriculitis episodes caused by multidrug-resistant organisms and reinforce the importance of a judicious use of antibiotics.

Resumen

Introducción

El objetivo del estudio fue analizar las características clínicas y microbiológicas de pacientes adultos con ventriculitis asociada a dispositivos de drenaje de líquido cefalorraquídeo (VaD-LCR).

Métodos

Estudio retrospectivo entre enero de 2010 y junio de 2019 realizado en el Complexo Hospitalario Universitario de Vigo (España). Se recogieron los casos de VaD-LCR y se analizaron las características clínicas, los tipos de drenaje, el tratamiento y los aislamientos microbiológicos.

Resultados

Se identificaron 99 episodios de VaD-LCR. Los microorganismos más frecuentemente aislados fueron los cocos grampositivos (65%), principalmente Staphylococcus epidermidis (48%). Se detectaron microorganismos multirresistentes en 21 episodios (23%). En el análisis multivariante, los factores asociados con VaD-LCR por cepas multirresistentes fueron la estancia hospitalaria > 14 días (HR: 6,7; IC 95%: 1,75-25,86; p = 0,006) y el uso previo de antibióticos (HR: 5,58; IC 95%: 1,44-21,65; p = 0,013).

Conclusiones

En nuestro estudio la tasa de VaD-LCR causada por bacterias multirresistentes fue elevada. Estos datos refuerzan la importancia del uso adecuado de antibióticos.

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.

Section snippets

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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