During the COVID-19 pandemic, patients in need of neurosurgical care suffered. Elective procedures were postponed, and emergency care visits decreased. Healthcare-associated ventriculitis (HAV) is a serious problem in children, with poor outcomes and frequent relapses. Our objective was to describe the clinical characteristics and the factors associated with a first HAV in children during two years of the pandemic. A retrospective cross-sectional study was performed from January 2021 to December 2022. The inclusion criteria were patients who developed a first HAV after a primary cerebrospinal fluid diversion procedure. The controls included patients without a first infection. Intraoperative and clinical data were extracted from medical records. A total of 199 CSF diversion surgeries were registered. A first infection occurred in 17 patients (8.5%), including 10 with external ventricular drain (EVD) and 6 with ventricular shunts. Gram-positive cocci were identified in 70.6%. Six patients recovered uneventfully, eight had relapse or superinfections, and three eventually died. Twenty patients were included as controls. Factors associated with a first infection were a younger age (median 9 vs. 102 months, < 0.01), malnutrition (23.5% vs. 0%, = 0.03), and an EVD placement (58.8% vs. 10%, = 0.03). None of the intraoperative factors showed statistically significant differences. The rate of HAV was high. Most cases presented in children <1 year and with an EVD.
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http://dx.doi.org/10.3390/antibiotics12101501 | DOI Listing |
Neurosurgery
December 2024
Department of Anesthesia, Burn and Critical Care, University Hospitals Saint-Louis - Lariboisière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.
Background And Objectives: Diagnosing ventriculostomy-related infection (VRI), a common complication after external ventricular drainage (EVD), is challenging and often associated with delayed initiation of antibiotic therapy. We aimed to develop a stewardship score to help in the decision of antibiotic therapy initiation when VRI is suspected.
Methods: This retrospective, single-center cohort study included patients admitted to the intensive care unit after EVD placement who were suspected of having healthcare-associated ventriculitis and/or meningitis between January 1, 2012, and August 31, 2022.
Sci Rep
November 2024
Neurocritical Care Unit, Institute for Intensive Care, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
BMC Infect Dis
October 2024
Division of Adult Neurology, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines, Manila, Philippines.
Background: The diagnosis of healthcare-associated ventriculitis and meningitis (HCAVM) can be complex because multiple factors confound the interpretation of cerebrospinal fluid (CSF) tests. The cell index (CI) may help in the diagnosis of HCAVM. It does not incur additional medical cost and it avoids delays from the turnaround time of CSF cultures.
View Article and Find Full Text PDFJ Surg Case Rep
September 2024
Institute of Microbiology and Parasitology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 50 Divizija 6, 1000 Skopje, Republic of North Macedonia.
Healthcare-associated central nervous system infections are a significant complication for patients undergoing neurosurgical interventions. We present a case of a 6-year-old patient with an embryonal tumor of the central nervous system. Following a craniotomy for the resection of the tumor, an external ventricular drainage was placed.
View Article and Find Full Text PDFDiagn Microbiol Infect Dis
May 2024
Dipartimento di Sicurezza e Bioetica - Sezione di Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy; Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
External ventricular drain-related cerebrospinal fluid infection represents a fearsome complication of neurosurgical interventions. Although vancomycin represents the standard of care for methicillin-resistant CoNS healthcare-associated ventriculitis, resistance phenomena have been described. We reported a case of a persistent external ventricular fluid drain infection after device removal by pandrug-resistant Staphylococcus epidermidis successfully treated with intravenous ceftaroline in combination with fosfomycin and vancomycin.
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