Background and objectives. Diagnosing ventriculostomy-related infection (VRI), a common complication after external ventricular drainage (EVD), is challenging and often associated with delayed initiation of antibiotic therapy. We aimed to develop a stewardship score to help in the decision of antibiotic therapy initiation when VRI is suspected. Methods. This retrospective, single-center cohort study included patients admitted to the intensive care unit after EVD placement who were suspected of having healthcare-associated ventriculitis and/or meningitis between January 1, 2012, and August 31, 2022. A multiple logistic regression model was used to identify factors associated with the development of healthcare-associated meningitis or ventriculitis after EVD placement. Results. A total of 331 patients were included. Eighty-one (23%) patients developed VRI between January 1, 2012, and August 31, 2022, whereas 250 (77%) did not (from January 1, 2018, to August 31, 2022). VRI-associated factors were EVD count >1 (odds ratio [OR] 3.69, P < .001), EVD duration >8 days (OR 6.71, P< .001), immunosuppression (OR 3.45, P = .028), recent neurosurgery (OR 7.74, P< .001), cerebrospinal fluid leak (OR 6.08, P < .001), and prophylactic antimicrobials (OR 0.26, P < .001). The VEntriculostomy-Related Infection score (VERI) score categorized VRI risk into 4 levels, with an area under the curve of 0.84. Conclusion. The VERI score is a robust, predictive tool for assessing the risk of VRI in patients with EVD, potentially guiding more judicious use of antibiotic therapy in the intensive care unit setting.
Repplinger S, Jacquier H, Verret A, et al. Neurosurgery. 2024. Doi: 10.1227/neu.0000000000003300. Online ahead of print.