The VEntriculostomy-Related Infection Score: An Antibiotic Stewardship Tool in Ventriculostomy-Related Infections.

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. A multiple logistic regression model was used to identify factors associated with the development of healthcare-associated meningitis or ventriculitis after EVD placement.

Results: A total of 331 patients were included. Eighty-one (23%) patients developed VRI between January 1, 2012, and August 31, 2022, whereas 250 (77%) did not (from January 1, 2018, to August 31, 2022). VRI-associated factors were EVD count >1 (odds ratio [OR] 3.69, P < .001), EVD duration >8 days (OR 6.71, P < .001), immunosuppression (OR 3.45, P = .028), recent neurosurgery (OR 7.74, P < .001), cerebrospinal fluid leak (OR 6.08, P < .001), and prophylactic antimicrobials (OR 0.26, P < .001). The VEntriculostomy-Related Infection score (VERI) score categorized VRI risk into 4 levels, with an area under the curve of 0.84.

Conclusion: The VERI score is a robust, predictive tool for assessing the risk of VRI in patients with EVD, potentially guiding more judicious use of antibiotic therapy in the intensive care unit setting.