Document Detail


Infections and re-infections in long-term external ventricular drainage. A variation upon a theme.
MedLine Citation:
PMID:  10735766     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The infection of the external ventricular drainage (EDV) remains the main morbidity and mortality associated with this procedure, in the setting of the treatment of hydrocephalus and its complications, leading to excess of hospitalization with annual economic burden. METHODS. In this 3-year retrospective study we selected and reviewed the records of 15 of 143 patients (mean age 34 years with range from 1 months to 70 years; 12 males and 3 females) undergone to prolonged EVD in the setting of management of hydrocephalus (5 patients because of acute ventricular dilation post-intraventricular hemorrhage or post-hemorrhagic HCP, 8 because of V-P shunt infection, 1 because of post-traumatic HCP and 1 because of shunt malfunction by elevated CSF protein) and developing a shunt infection or one or more superinfection. RESULTS: There was a 26% mortality and a 13% morbidity (1 patient had GOS score of 2, 1 score of 3 and 3 score of 5). The pathogens yielded by CSF culture were normal or transient flora of the patient's skin. The causes of infection were carefully analyzed. CONCLUSIONS: Based on our experience the management of infection in long-term EVD includes: the standardization of the environment of the surgery achieved with a) use of prophylactic antibiotics; b) preparation of the patient and sterile field; c) no touch technique. After implantation of EVD the risk of infection must be minimized by carefully nursing care of EVD, and administration of above prophylactic antibiotics. CSF must be collected for culture and cell count, glucose and protein when clinically indicated. When infection o reinfection is demonstrated by CSF culture then it is advisable to remove the entire hardware and start the antibiotic therapy intravenously and intraventricularly basing on susceptibility tests, CSF penetration of antibiotics, their bactericidal action, toxicity, specificity and cost. Regard to the duration of the therapy, a practical guide is treating for 10-14 days after three consecutive CSF sterile cultures. Thus, convention of EVD to a shunt can be performed within 3 weeks from admission, in the best favourable cases, decreasing the duration of hospital stay and the overall cost of neurosurgical management of the cerebral pathology requiring as therapeutic adjunct and EVD.
Authors:
A Zingale; S Ippolito; P Pappalardo; S Chibbaro; R Amoroso
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Journal of neurosurgical sciences     Volume:  43     ISSN:  0390-5616     ISO Abbreviation:  J Neurosurg Sci     Publication Date:  1999 Jun 
Date Detail:
Created Date:  2000-04-25     Completed Date:  2000-04-25     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0432557     Medline TA:  J Neurosurg Sci     Country:  ITALY    
Other Details:
Languages:  eng     Pagination:  125-32; discussion 133     Citation Subset:  IM    
Affiliation:
Division of Neurosurgery, Azienda Ospedaliera di ARSN, Garibaldi, S. Luigi-S. Currò, Ascoli-Tomaselli, Hospitals, University of Catania, Italy.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Anti-Bacterial Agents / therapeutic use
Central Nervous System Bacterial Infections / etiology*,  microbiology,  prevention & control
Cerebrospinal Fluid Shunts / adverse effects*
Child
Female
Humans
Hydrocephalus / complications,  surgery*
Infant
Male
Middle Aged
Postoperative Complications / etiology*,  microbiology,  prevention & control
Recurrence
Retrospective Studies
Treatment Outcome
Ventriculostomy / adverse effects*
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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