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31.07.2018 | Original Article - Neurosurgical intensive care | Ausgabe 10/2018

Acta Neurochirurgica 10/2018

Modalities and accuracy of diagnosis of external ventricular drainage-related infections: a prospective multicentre observational cohort study

Acta Neurochirurgica > Ausgabe 10/2018
J. Berger-Estilita, M. Passer, M. Giles, J. Wiegand, Tobias M. Merz
Wichtige Hinweise
This article is part of the Topical Collection on Neurosurgical Intensive Care


We would like to disclosure that partial results of this study were presented as conference poster entitled “Does antibiotic prophylaxis influence the incidence of EVD-related infections? A prospective multicentre study” at the 30th Annual Congress of the European Society of Intensive Care Medicine (ESICM), held in Vienna on the 23-27 September 2017.



Device infection is a major complication of placement external ventricular drains (EVD). Diagnostic features are often masked by underlying disease or cerebrospinal fluid (CSF) contamination by blood. We aim to assess which diagnostic modalities are applied for EVD-related infection (ERI) diagnosis and evaluate their accuracy.


This observational prospective study included 187 adult patients with an EVD. Modalities of clinical diagnosis of ERI diagnosed by treating physicians on clinical grounds and blood and CSF analysis (clinically diagnosed ERI (CD-ERI)) were assessed prospectively. Additionally, the diagnostic accuracy of clinical and laboratory parameters for the diagnosis of culture proven ERI (CP-ERI) was evaluated, using data of the study patients and including a retrospective cohort of 39 patients with CP-ERI.


Thirty-one CD-ERIs were diagnosed in the prospective cohort. Most physicians used CSF analysis to establish the diagnosis. ROC analysis revealed an AUC of 0.575 (p = 0.0047) for the number of positive SIRS criteria and AUC of 0.5420 (p = 0.11) for the number of pathological neurological signs for diagnosis of CP-ERI. Diagnostic accuracy of laboratory values was AUC 0.596 (p = 0.0006) for serum white blood cell count (WBCC), AUC 0.550 (p = 0.2489) for serum C-reactive protein, AUC 0.644 (p < 0.0001) for CSF WBCC and AUC 0.690 for CSF WBC/red blood cell count ratio (both p < 0.0001). Neither a temporal trend in potential predictors of CP-ERI nor a correlation between clinical diagnosis and proven CSF infection was found.


Clinicians base their diagnosis of ERI mostly on CSF analysis and occurrence of fever, leading to over-diagnosis. The accuracy of the clinical diagnosis is low. Commonly used clinical and laboratory diagnostic criteria have a low sensitivity and specificity for ERI.

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