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Ventriculostomy-associated infections: incidence and risk factors [Article de Revue]

 
[Infections associées à la ventriculostomie : incidence et facteurs de risque]
ARABI Y ; Memish, Ziad Ahmed ; Balkhy, Hanan H ; FRANCIS C ; FERAYAN A ; AL SHIMEMERI A ; ALMUNEEF MA
American journal of infection control. 2005/04; 33(3) : 137-143
Summary: Le but de cette étude était d'évaluer l'incidence des infections liées à la ventriculostomie (IAV) et d'étudier les facteurs de risque qui y sont associés. On a rassemblé toutes les données des patients consécutifs porteurs de cathéters de ventriculostomie admis en unité de réanimation dans un centre hospitalier d'Arabie Saoudite durant 3 ans (mars 1999 - février 2002). Les données concernant le patient étaient : démographiques, sévérité de la maladie, l'indication de cathéter, fuite du LCR, durée de séjour, mortalité. Les données sur le cathéter étaient : lieu de mise en place du cathéter (bloc opératoire ou non), usage d'antibiotique en irrigation ou antibioprophylaxie, nombre de journées de cathétérisme) ; la fréquence des prélèvements de LCR a été notée. Au total, 84 patients ont été inclus et pour lesquels on a placé 99 cathéters parmi lesquels 19 % ont développé une IAV. Il y a eu au total 586 journées cathéter (taux d'infection : 32 pour 1000 journées-cathéter).En conclusion, le risque d'IAV augmente avec la durée du cathétérisme et avec des insertions répétées. L'usage d'une irrigation locale par antibiotique ou les antibiotiques systémiques ne réduisant pas le risque d'IAV. Les cultures de surveillance en routine du LCR n'ont pas plus détecté d'infection que les cultures obtenues après indication clinique.

BACKGROUND: The objective of this study was to assess the incidence of ventriculostomy-associated infections (VAI) and to examine the related risk factors. METHODS: Data on all consecutive patients with ventriculostomy catheters admitted to the intensive care unit (ICU) in a tertiary care center over a 3-year period were identified from the ICU database and from medical records. VAI was documented using a preset definition. The following patient data were documented: demographics, severity of illness measures, indication for the catheter, presence of cerebrospinal fluid (CSF) leak, and length of stay and mortality. The following catheter data were collected: venue of catheter placement (operating room or nonoperating room areas), use of antibiotic irrigation and prophylactic systemic antibiotics, and number of catheter days. The frequency of CSF sampling was documented. RESULTS: In 84 patients, 99 catheters were placed, of which 19% developed VAI. There was a total of 586 catheter days (infection rate, 32 per 1000 catheter days). The risk of VAI increased steadily until catheter day 7 then reached a plateau. Among patients' factors, repeat catheter insertion was associated with a significant increase in VAI. There were no significant associations with age, severity of illness, indication for the catheter, craniatomy, or presence of CSF leak. Among catheter factors, the number of catheter days and repeat catheter insertion emerged as significant independent predictors on multivariate analysis. Placement outside the operating room was associated with a trend toward higher VAI. The use of prophylactic antibiotic or antibiotic irrigation did not significantly alter VAI rates. Routine surveillance cultures of CSF were no more likely to detect infection than cultures obtained when clinically indicated. Gram-negative bacilli were responsible for 50% of the infections, followed by gram-positive cocci (29%) and others (21%). CONCLUSIONS: The risk of VAI increases with increasing duration of catheterization and with repeated insertions. The use of local antibiotic irrigation or systemic antibiotics does not appear to reduce the risk of VAI. Routine surveillance cultures of CSF were no more likely to detect infection than cultures obtained when clinically indicated. These findings need to be considered in infection control policies addressing this important issue.(RESUME D'AUTEUR)
Publication
2005/04

Pages
137-143

Language
Anglais

Number of ref
16

Published in
American journal of infection control

Ventriculostomie
ID notice
318830

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