Ventriculostomy-related infections: The performance of different definitions for diagnosing infection

Abstract

Introduction. Comparison of rates of ventriculostomy-related infections (VRIs) across institutions is difficult due to the lack of a standard definition. We sought to review published definitions of VRI and apply them to a test cohort to determine the degree of variability in VRI diagnosis. Materials and methods. We conducted a PubMed search for definitions of VRI using the search strings “ventriculostomy-related infection” and “ventriculostomy-associated infection.” We applied these definitions to a test cohort of 18 positive cerebrospinal fluid (CSF) cultures taken from ventriculostomies at two institutions to compare the frequency of infection using each definition. Results. We found 16 unique definitions of VRI. When the definitions were applied to the test cohort, the frequency of infection ranged from 22 to 94% (median 61% with interquartile range (IQR) 56–74%). The concordance between VRI diagnosis and treatment with VRI-directed antibiotics for at least seven days ranged from 56 to 89% (median: 72%, IQR: 71–78%). Conclusions. The myriad of definitions in the literature produce widely different frequencies of infection. In order to compare rates of VRI between institutions for the purposes of qualitative metrics and research, a consistent definition of VRI is needed.

Keywords::

• cerebrospinal fluid
• CSF shunt
• infection
• ventriculitis
• surgical-site infection

Declaration of interest: Ariane Lewis, Sarah Wahlster, Sarah Karinja, and Barry Czeisler do not have any financial conflicts of interest. Aaron Lord received support from the NYU-HHC Clinical and Translational Science Institute via grant UL1 TR000038 from the National Center for Advancing Translational Sciences of the National Institutes of Health. W. Taylor Kimberly receives support from the Andrew David Heitman Neurovascular Research Foundation. The Foundation had no role in study design, collection, analysis, interpretation of data, writing of the manuscript, or decision to submit the manuscript for publication.

Supplementary material available online

Supplementary Appendix I to be found online at http://informahealthcare.com/doi/abs/10.3109/02688697.2015.1080222.