RACT
Objective: To evaluate the usefulness of clinical signs, blood tests, microbiological cultures and cerebrospinal fluid
(CSF) analysis to detect ventriculostomy related infections (VRI), and to describe related conditions.
Methods: A retrospective study was carried out including all patients with external ventricular drain admitted to
intensive care unit from January 2000 to December 2006. Diagnosis of VRI, mortality, demographic and clinical data,
time and number of drains, microbiological and biochemical CSF results and blood test were recorded. Difference
between infected and uninfected patients was statistically significant at P < 0.05.
Results: The results revealed 136 drainages in 120 patients with 22 (18.33%) infected (15.39 infections per 1 000 days
of drainage). This group was on overage older, had more severe sistemic response syndrom and a significantly higher
number of drains and longer duration of drain insertion. We found statistical differences in proteinorrachia,
glycorrhachia, and glycorrachia/glycemia ratio during 8.5 day-drain insertion (intercuartile range 7–10.25). A total of
31 cultures were positive in patients without VRI and 47 were negative in patients with VRI. Furthermore, 35 patients
died (2 belonging to the infected group). Significantly higher risk of VRI in intraventricular fibrinolysis and
subaracnoid haemorrhage was observed. We made a multivariate regression model resulting in a prediction rule with
55.7% area under curve (95% CI 0.43–0.70).
Conclusions: CSF routine cultures and biochemical studies are not recommended to diagnose VRI. Clinical signs,
external ventricular drain manipulation and a drainage insertion over a week justify the routine measurement of
proteinorrachia, glycorrachia and the ratio of glycorrachia/glycemia.