ABSTRACT
Background and objectives: Few prospective well-designed diagnostic accuracy studies have been performed to study the parameters of infection in patients suspected for external ventricular catheter-associated infection. Our objective was to analyze the diagnostic accuracy of clinical characteristics and biochemical and microbiological parameters in diagnosing external ventricular cerebrospinal fluid (CSF) catheter-associated infection.
Methods: From 2014 to 2017 we performed a single-center cohort study in consecutive patients at the intensive care unit who required an external ventricular CSF catheter in the Hague, the Netherlands. CSF was sampled and analyzed daily. Ventricular catheter-associated infection was defined according to the 2017 Infectious Diseases Society of America's Clinical Practice Guidelines. We compared clinical characteristics and biochemical parameters between patients with and without infection from 3 days prior to 3 days after the day the CSF sample was collected that grew bacteria.
Results: 103 patients were included of whom 15 developed a catheter-associated infection (15%). The median day cultures were positive was 3 days after CSF collection (IQR +2 to +4). On day 0, none of the tests could differentiate between patients with and without infection. CSF leukocyte count was increased in patients with ventricular catheter-associated infection as compared to patients without on day +2 and +3. The difference was most prominent on day +2 (1,703 × 106/L [IQR 480-6296] vs. 80 × 106/L [IQR 27-251]; p < 0.001; AUC 0.87 [CI 0.71-1.00]). Sensitivity for CSF leukocyte count at a cut off level >1,000 × 106/L was 67% (95% CI 30-93) and specificity was 100% (95% CI 90-100), the positive predictive value was 100% and the negative predictive value was 92% (95% CI 83-97). The percentage polymorphonuclear cells was higher in patients with infection on day +1 and +2 (day +2 89% [IQR 78-94] vs 59% [IQR 39-75]; p < 0.01; AUC 0.91 [95% CI 0.81-1.0]).
Discussion: An elevated CSF leukocyte count and increased percentage polymorphonuclear cells are the strongest indicators for external catheter-associated infections on the days prior to culture positivity. New CSF markers of drain-associated infection should be studied to enable earlier diagnosis and treatment in patients with an infection, and reduce antibiotic treatment in those with no infection.
Classification of Evidence: This study provides Class I evidence that in individuals requiring an external ventricular CSF catheter, elevated CSF leukocyte count and an increased percentage polymorphonuclear cells are the strongest indicators of catheter-associated infections in the days prior to CSF culture positivity.
- Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.
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