Soonchunhyang Med Sci.  2013 Dec;19(2):51-55.

Characteristics of Device-Associated Cerebrospinal Fluid Infection in Adults

Affiliations
  • 1Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea. shegets@schmc.ac.kr

Abstract


OBJECTIVE
Device-associated infections in the central nervous system are serious complications of procedures involving indwelling devices among neurosurgical patients. In this study, the clinical characteristics and outcome of microbiologically confirmed device-associated cerebrospinal fluid (CSF) infection were evaluated.
METHODS
We performed a retrospective analysis of adult patients found to have a positive CSF culture result during a hospital admission between 1 January 2005 through 2 October 2010 in Soonchunhyang University Hospital.
RESULTS
During the study period, all episodes (n=161 CSF specimens, 87 patients) involving a culture-positive CSF were enrolled. Thirty-two episodes of device-associated CSF infection were included in the analysis among the study group. Most device-associated infections were ventriculo-peritoneal shunt infections (14/32, 44%). Fever (>38degrees C) was present in 17 episodes (53%). Overall, the most common microorganism was coagulase-negative staphylococcus (7/32 [22%]). Gram-negative rods (Pseudomonas aeruginosa 6/32 [19%], Acinetobacter baumannii/haemolyticus 5/32 [16%]) were identified in culture in 16/32 (50%). Device was removed for the control of device-associated infection in 30/32 (94%). Cure rate was 69% (22/32). All patients with treatment failure (10/32, 34%) expired.
CONCLUSION
It is difficult to diagnosis device-associated CSF infections early since those are frequently presented with nonspecific clinical signs and symptoms. In our study, gram-negative infections accounted for 50% of cases and the empiric antibiotics initially chosen were found to not be effective against the final identified pathogen in many cases. Device-associated CSF infections should be strongly considered a serious risk factor associated with CSF infections, and prompt initiation of broad coverage antibiotics should be started after appropriate assessment.

Keyword

Nosocomial bacterial meningitis; Cerebrospinal fluid infection; Device-associated; Meningitis; Cerebral ventriculitis

MeSH Terms

Acinetobacter
Adult*
Anti-Bacterial Agents
Central Nervous System
Cerebral Ventriculitis
Cerebrospinal Fluid*
Diagnosis
Fever
Humans
Meningitis
Retrospective Studies
Risk Factors
Staphylococcus
Treatment Failure
Ventriculoperitoneal Shunt
Anti-Bacterial Agents
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