2025 Southeastern Residency Conference

Title: Characterization of External Ventricular Drain-Associated Ventriculitis
Authors: Jordan Glasgow (Jordan.Glasgow@wellstar.org), Joy Peterson, Karen Barlow 
Objective: Identify risk factors for developing ventriculitis after the placement of an EVD. 
Self-assessment Question: Which of the following may be a risk factor for EVD-associated ventriculitis?  
Background: Hospital-acquired infections (HAI) increase morbidity, mortality, and healthcare costs. However, HAI associated with external ventricular drains (EVDs) are not routinely tracked. Surveillance of these infections can help identify risk factors, causative pathogens, and preventative strategies. The aim of this study is to characterize patients who develop ventriculitis after EVD placement in a large community teaching hospital. We seek to identify practical monitoring parameters and modifiable risk factors to improve patient outcomes in the neurocritical care unit. 
Methods: This is an observational, retrospective chart review of patients admitted to Wellstar Kennestone Regional Medical Center (WKRMC) from December 2021 to August 2024 with a diagnosis of ventriculitis after EVD placement. Additional eligibility criteria are patients ≥ 18 years of age with an EVD in place ≥ 24 hours. Descriptive statistics were performed are the data.   
Results: A total of eighteen EVDs were placed in nine patients with ventriculitis in this IRB-approved study. Each patient had a median of two EVDs installed during their stay and received an average of 15.5 ± 11.12 days of antibiotic therapy. The median length of stay in the neurocritical care unit (neuro ICU) and hospital was 28 days (25-29) and 31 days (25-34), respectively. Two EVDs were placed in the Emergency Department (ED) (11.1%), seven EVDs were placed in the neurocritical care unit (ICU) (38.9%), and nine EVDs were placed in the operating room (50%). Ten of the eighteen EVDs (55.6%) were associated with ventriculitis. Of these ten EVDs, five were linked to culture confirmed ventriculitis, while the other five were associated with a clinical diagnosis of ventriculitis. All EVDs placed in the ED were linked to ventriculitis, while four EVDs placed in both the neuro ICU and OR were also linked to ventriculitis. Among the EVDs associated with culture positive ventriculitis, three were used for intrathecal medication administration. The isolated pathogens in cultured confirmed ventriculitis include Enterobacter cloacae, Neisseria spp, Serratia marcescens, and non-ESBL Klebsiella aerogenes.
Conclusion: Insertion of multiple EVDs and EVD manipulation may be associated with the development of ventriculitis. Additionally, the number of bedside EVDs linked to ventriculitis may be similar to those placed in the operating room. However, further studies including patients who do not develop ventriculitis after EVD placement as a comparator are needed to assess the incidence of ventriculitis following bedside installation.