PMID- 36267249 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20221022 IS - 2328-8957 (Print) IS - 2328-8957 (Electronic) IS - 2328-8957 (Linking) VI - 9 IP - 10 DP - 2022 Oct TI - Comparison of Suspected and Confirmed Internal External Ventricular Drain-Related Infections: A Prospective Multicenter United Kingdom Observational Study. PG - ofac480 LID - 10.1093/ofid/ofac480 [doi] LID - ofac480 AB - BACKGROUND: Diagnosis of internal external ventricular drain (EVD)-related infections (iERI) is an area of diagnostic difficulty. Empiric treatment is often initiated on clinical suspicion. There is limited guidance around antimicrobial management of confirmed versus suspected iERI. METHODS: Data on patients requiring EVD insertion were collected from 21 neurosurgical units in the United Kingdom from 2014 to 2015. Confirmed iERI was defined as clinical suspicion of infection with positive cerebrospinal fluid (CSF) culture and/or Gram stain. Cerebrospinal fluid, blood, and clinical parameters and antimicrobial management were compared between the 2 groups. Mortality and Modified Rankin Scores were compared at 30 days post-EVD insertion. RESULTS: Internal EVD-related infection was suspected after 46 of 495 EVD insertions (9.3%), more common after an emergency insertion. Twenty-six of 46 were confirmed iERIs, mostly due to Staphylococci (16 of 26). When confirmed and suspected infections were compared, there were no differences in CSF white cell counts or glucose concentrations, nor peripheral blood white cell counts or C-reactive protein concentrations. The incidence of fever, meningism, and seizures was also similar, although altered consciousness was more common in people with confirmed iERI. Broad-spectrum antimicrobial usage was prevalent in both groups with no difference in median duration of therapy (10 days [interquartile range IQR, 7-24.5] for confirmed cases and 9.5 days [IQR, 5.75-14] for suspected, P = 0.3). Despite comparable baseline characteristics, suspected iERI was associated with lower mortality and better neurological outcomes. CONCLUSIONS: Suspected iERI could represent sterile inflammation or lower bacterial load leading to false-negative cultures. There is a need for improved microbiology diagnostics and biomarkers of bacterial infection to permit accurate discrimination and improve antimicrobial stewardship. CI - (c) The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America. FAU - Sohn, Sei Yon AU - Sohn SY AUID- ORCID: 0000-0003-2099-4092 AD - Division of Anaesthesia, University of Cambridge, Cambridge, United Kingdom. FAU - Russell, Clark D AU - Russell CD AD - Queen's Medical Research Institute, University of Edinburgh Centre for Inflammation Research, Edinburgh, United Kingdom. FAU - Jamjoom, Aimun A B AU - Jamjoom AAB AD - Department of Clinical Neuroscience, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom. FAU - Poon, Michael T AU - Poon MT AD - Department of Clinical Neuroscience, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom. FAU - Lawson McLean, Aaron AU - Lawson McLean A AD - Department of Neurosurgery, Jena University Hospital - Friedrich Schiller University Jena, Jena, Germany. FAU - Ahmed, Aminul I AU - Ahmed AI AD - Department of Neurosurgery, Wolfson CARD, King's College London, King's College Hospital, London, United Kingdom. CN - British Neurosurgical Trainee Research Collaborative LA - eng PT - Journal Article DEP - 20220917 PL - United States TA - Open Forum Infect Dis JT - Open forum infectious diseases JID - 101637045 PMC - PMC9578167 OTO - NOTNLM OT - antimicrobial treatment OT - aseptic meningitis OT - external ventricular drain OT - intraventricular antimicrobials OT - post-neurosurgical meningitis COIS- Potential conflicts of interest. All authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. FIR - Abdulla, Mah IR - Abdulla M FIR - Alalade, A IR - Alalade A FIR - Bailey, M IR - Bailey M FIR - Basu, S IR - Basu S FIR - Baudracco, I IR - Baudracco I FIR - Bayston, R IR - Bayston R FIR - Bhattacharya, A IR - Bhattacharya A FIR - Bodkin, P IR - Bodkin P FIR - Boissaud-Cooke, M IR - Boissaud-Cooke M FIR - Bojanic, S IR - Bojanic S FIR - Brennan, P M IR - Brennan PM FIR - Bulters, D O IR - Bulters DO FIR - Buxton, N IR - Buxton N FIR - Chari, A IR - Chari A FIR - Corns, R IR - Corns R FIR - Coulter, C IR - Coulter C FIR - Coulter, I IR - Coulter I FIR - Critchley, G IR - Critchley G FIR - Dando, A IR - Dando A FIR - Dardis, R IR - Dardis R FIR - Duddy, J IR - Duddy J FIR - Dyson, E IR - Dyson E FIR - Edwards, R IR - Edwards R FIR - Garnett, M IR - Garnett M FIR - Gatcher, S IR - Gatcher S FIR - Georges, H IR - Georges H FIR - Glancz, L J IR - Glancz LJ FIR - Gray, W P IR - Gray WP FIR - Hallet, J IR - Hallet J FIR - Harte, J IR - Harte J FIR - Haylock-Vize, P IR - Haylock-Vize P FIR - Hutchinson, P J IR - Hutchinson PJ FIR - Humphreys, H IR - Humphreys H FIR - Jenkinson, M D IR - Jenkinson MD FIR - Joannides, A J IR - Joannides AJ FIR - Kandasamy, J IR - Kandasamy J FIR - Kitchen, J IR - Kitchen J FIR - Kolias, A G IR - Kolias AG FIR - Loan, Jjm IR - Loan J FIR - Ma, R IR - Ma R FIR - Madder, H IR - Madder H FIR - Mallucci, C L IR - Mallucci CL FIR - Manning, A IR - Manning A FIR - Mcelligott, S IR - Mcelligott S FIR - Mukerji, N IR - Mukerji N FIR - Narayanamurthy, H IR - Narayanamurthy H FIR - O'Brien, D IR - O'Brien D FIR - Okasha, M IR - Okasha M FIR - Papadopoulos, M IR - Papadopoulos M FIR - Phan, V IR - Phan V FIR - Phang, I IR - Phang I FIR - Poots, J IR - Poots J FIR - Rajaraman, C IR - Rajaraman C FIR - Roach, J IR - Roach J FIR - Ross, N IR - Ross N FIR - Sharouf, F IR - Sharouf F FIR - Shastin, D IR - Shastin D FIR - Simms, N IR - Simms N FIR - Steele, L IR - Steele L FIR - Solth, A IR - Solth A FIR - Tajsic, T IR - Tajsic T FIR - Talibi, S IR - Talibi S FIR - Thanabalasundaram, G IR - Thanabalasundaram G FIR - Vintu, M IR - Vintu M FIR - Wan, Y IR - Wan Y FIR - Wang, D IR - Wang D FIR - Watkins, L IR - Watkins L FIR - Whitehouse, K IR - Whitehouse K FIR - Whitfield, P C IR - Whitfield PC FIR - Williams, A IR - Williams A FIR - Zaben, M IR - Zaben M EDAT- 2022/10/22 06:00 MHDA- 2022/10/22 06:01 PMCR- 2022/09/17 CRDT- 2022/10/21 02:48 PHST- 2022/06/22 00:00 [received] PHST- 2022/09/14 00:00 [accepted] PHST- 2022/10/21 02:48 [entrez] PHST- 2022/10/22 06:00 [pubmed] PHST- 2022/10/22 06:01 [medline] PHST- 2022/09/17 00:00 [pmc-release] AID - ofac480 [pii] AID - 10.1093/ofid/ofac480 [doi] PST - epublish SO - Open Forum Infect Dis. 2022 Sep 17;9(10):ofac480. doi: 10.1093/ofid/ofac480. eCollection 2022 Oct.