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Master Thesis

Ventriculostomy-related infections. A practice survey

Abstract : Ventriculostomy related infections (VRI) are frequent, damaging and difficult to treat. The diagnostic methods and management of VRI are very heterogeneous, because evidence is lacking. The aim of our study is to evaluate the practices of neuro intensive care units in French-speaking European countries. Materials and methods: this was a practice survey realized with an online questionnaire. The questionnaire included 30 items about 4 main topics (management of external ventricular drains (EVD), diagnosis of VRI, management of VRI, intraventricular antibiotic therapy). It was sent to intensive care units specialized in neurology and neurosurgery, in French-speaking European countries. Results: the majority of centers (85,3%) place their EVDs exclusively in the operating room, 61,8% of the participants never use antibiotic prophylaxis during the placement and 79,4% never use anti-infective impregnated EVD catheters. To help diagnose VRI, 38,2% of participants use the cerebrospinal fluid (CSF) lactate assay, 17,6% use the blood procalcitonin (PCT) assay, 67,6% use the cell index, and 79,4% sometimes use the 16S RNA PCR on the CSF. In case of suspected VRI, only 26,5% of participants perform brain imaging systematically. For suspected VRI, the most common empiric antibiotic is Linezolid (48.5%) for staphylococcus, and Meropenem (39.5%) for GNB. For documented methicillin-sensitive staphylococcus infections, the most prescribed antibiotic is Oxacillin (44.1%); for methicillin-resistant staphylococcus, the most frequent antibiotic is Linezolid (52.9%). Most participants (88.2%) sometimes use intraventricular antibiotic therapy, but never routinely. The majority of participants (76,5%) systematically perform CSF analysis to monitor the effectiveness of the treatment. Conclusion: this study reveals that the management of ventriculostomy-related infections is highly heterogeneous between specialized centers in French-speaking Europe. This is due to the fact that the literature is not extensive on this subject, and current knowledge is mainly based on retrospective and small sample studies. It seems necessary to conduct randomized studies on this subject. European and French recommendations should help physicians to standardize their practices.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03472101
Contributor : Faculté de Médecine UM Connect in order to contact the contributor
Submitted on : Thursday, December 9, 2021 - 10:34:38 AM
Last modification on : Friday, August 5, 2022 - 10:57:55 AM

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Nicolas Dubois. Ventriculostomy-related infections. A practice survey. Human health and pathology. 2021. ⟨dumas-03472101⟩

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