Table 1.
Baseline Characteristics and Predictors for One-Year Mortality in 98 Patients With Ventriculitis
| Characteristics | Total, n = 98 (%) | Survivor, n = 60 (%) | Nonsurvivor, n = 38 (%) | P Value |
|---|---|---|---|---|
| Baseline Characteristics Before Diagnosis of Ventriculitis | ||||
| Age, years | 60 [48–68] | 58 [47–66] | 65 [54–74] | .01 |
| Male gender | 69 (70.4) | 38 (63.3) | 31 (81.6) | .07 |
| Neurological disease | 37 (37.8) | 24 (40) | 13 (34.2) | .67 |
| Neurosurgery ≥1 year before ventriculitis | 5 (5.1) | 3 (5) | 2 (5.3) | 1 |
| Neurosurgery <1 year | 26 (26.5) | 15 (25) | 11 (28.9) | .81 |
| Neurosurgical device | 20 (20.4) | 12 (20) | 8 (21.1) | 1 |
| Ventriculoperitoneal shunt | 6 (6.1) | 5 (8.3) | 1 (2.6) | .40 |
| EVD | 12 (12.2) | 5 (8.3) | 7 (18.4) | .21 |
| EVD duration, days | 11 [9–15] | 13 [10–14] | 10 [9–15.5] | .75 |
| Craniotomia | 12 (12.2) | 8 (13.3) | 4 (10.5) | .76 |
| Head trauma | 7 (7.1) | 4 (6.7) | 3 (7.9) | 1 |
| Brain hemorrhage | 16 (16.3) | 9 (15) | 7 (18.4) | .81 |
| CSF leak | 12 (12.2) | 10 (16.7) | 2 (5.3) | .12 |
| Comorbidities | ||||
| Diabetes mellitus | 19 (19.4) | 10 (16.7) | 9 (23.7) | .44 |
| Immunosuppression | 18 (18.4) | 9 (15) | 9 (23.7) | .3 |
| Malignancy | 14 (14.3) | 5 (8.3) | 8 (21.1) | .12 |
| Alcohol abuse | 21 (21.4) | 10 (16.7) | 11 (28.9) | .21 |
| Cirrhosis | 6 (6.1) | 3 (5) | 3 (7.9) | .67 |
| Hypertension | 30 (30.6) | 15 (25) | 15 (39.5) | .18 |
| Chronic Treatment | ||||
| Corticosteroids | 10 (10.2) | 6 (10) | 4 (10.5) | 1 |
| Nonsteroidal anti-inflammatory drugs | 5 (5.1) | 4 (6.7) | 1 (2.6) | .65 |
| Symptoms at Presentation | ||||
| Fever | 83/90 (92.2) | 52/57 (91.2) | 31/33 (94) | 1 |
| Body temperature, °C | 39.0 [38.6–39.5] | 39 [38.6–39.4] | 39.1 [38.6–39.5] | .73 |
| Neck stiffness | 45/77 (58.4) | 35/51 (68.6) | 10/26 (38.5) | .01 |
| Photophobia/phonophobia | 26/65 (40) | 21/44 (47.7) | 5/21 (23.8) | .10 |
| Nausea | 18/66 (27.2) | 13/42 (31) | 5/24 (20.8) | .57 |
| Headache | 50/67 (74.6) | 36/46 (78.2) | 14/21 (66.7) | .37 |
| Glasgow Coma Scale score | 11 [8–14] | 14 [10–14] | 9 [7–13] | <.001 |
| Seizures | 18/97 (18.6) | 7/59 (11.9) | 11 (28.9) | .06 |
| Focal neurological signs | 30/95 (31.6) | 17/57 (29.8) | 13 (34.2) | .66 |
| Etiologies | ||||
| Community-acquired ventriculitisa | 68 (69.4) | 45 (73.3) | 24 (63.2) | .37 |
| Primary bacterial meningitis | 27 (27.5) | 17 (28.3) | 10 (26.3) | 1 |
| Community-acquired brain abscess(es) | 29 (29.6) | 18 (30) | 11 (28.9) | 1 |
| Hematogenousb | 12 (12.2) | 9 (15) | 3 (7.9) | .36 |
| Healthcare-associated ventriculitisc | 30 (30.6) | 16 (26.7) | 14 (36.8) | .37 |
| Neurosurgical site infectiond | 13 (13.3) | 8 (13.3) | 5 (13.2) | 1 |
| Ventricular catheter-related | 17 (17.3) | 9 (15) | 8 (21.1) | .58 |
| CSF Parameters | ||||
| Lumbar puncture | 87 (88.8) | 54 (90) | 33 (86.8) | .75 |
| White cells count/mm3 | 2650 [651–6725] | 2461 [687–6075] | 2850 [660–7250] | .60 |
| Neutrophils, % | 90 [82–96] | 86 [80–95] | 92 [86–97] | .08 |
| Protein, g/L | 3.6 [1.9–5.8] | 2.9 [1.5–4.8] | 4.2 [3–7.7] | .006 |
| Glucose, mmol/L | 0.7 [0.1–2.2] | 0.8 [0.3–2.4] | 0.5 [0.04–1.7] | .16 |
| Microbiology | ||||
| Positive CSF Gram stain | 41/87 (47) | 22/54 (40.7) | 19/33 (57.6) | .12 |
| Positive CSF culture | 53/87 (60.9) | 29/54 (53.7) | 24/33 (72.7) | .04 |
| Positive blood culture | 32/92 (34.8) | 23/57 (40.4) | 9/35 (25.7) | .18 |
| Identification by 16S rRNAe | 12/34 (35.3) | 6/22 (27.3) | 6/12 (50) | .27 |
| Staphylococci | 15 (15.3) | 8 (13.3) | 7 (18.4) | .57 |
| Staphylococcus aureus | 9 (9.1) | 5 (8.3) | 4 (10.5) | |
| Streptococci | 44 (44.9) | 30 (50) | 14 (36.8) | .22 |
| Streptococcus pneumoniae | 22 (22.4) | 15 (25) | 7 (18.4) | |
| milleri group | 13 (13.3) | 8 (13.3) | 5 (13.2) | |
| Gram-negative bacilli | 27 (27.6) | 14 (23.3) | 13 (34.2) | .26 |
| Pseudomonas aeruginosa | 4 (4.1) | 0 (0) | 4 (10.5) | .02 |
| Strict anaerobes | 9 (8.1) | 6 (10) | 3 (7.9) | 1 |
| Fungi | 1 (1) | 1 (1.7) | 0 (0) | 1 |
Abbreviations: CSF, cerebrospinal fluid; EVD, external ventricular drain; IQR, interquartile range; rRNA, ribosomal ribonucleic acid.
NOTE: Data are presented as median [IQR] or number (%).
aCommunity-acquired ventriculitis pathogens: Streptococcus pneumoniae (n = 22), other Streptococci (n = 9), Streptococcus intermedius (n = 6), Porphyromonas sp (n = 5), Streptococcus constellatus (n = 4), Pseudomonas aeruginosa (n = 2), Staphyloccocus aureus (n = 2), Escherichia coli (n = 2), Prevotella sp (n = 2), Fusobacterium sp (n = 2), Streptococcus anginosus (n = 1), Haemophilus influenzae (n = 1), Neisseria meningitidis (n = 1), Listeria monocytogenes (n = 1), Klebsiella sp (n = 1), Cutibacterium acnes (n = 1), Actinomyces meyeri (n = 1), Nocardia nova (n = 1), Aggregatibacter aphrophilus (n = 1), Parvimonas micra (n = 1), Bulleidia sp (n = 1), Eikenella corrodens (n = 1).
bHematogenous ventriculitis included sustained bacteremia due to infective endocarditis (n = 6), vertebral osteomyelitis without infective endocarditis (n = 4), arthritis (n = 1), and abdominal infection (n = 1).
cHealthcare-associated ventriculitis pathogens: S aureus (n = 7), coagulase-negative staphylococci (n = 6), Enterobacter sp (n = 5), Escherichia coli (n = 4), Klebsiella sp (n = 3), P aeruginosa (n = 2), S constellatus (n = 2), H influenzae (n = 1), Candida albicans (n = 1).
dIncluded nosocomial brain abscess (n = 3) and empyema (n = 2).
ePathogens detected by 16S rRNA were as follows, in survivors: S pneumoniae (n = 1), S intermedius (n = 1), Enterobabacter sp (n = 1), Porphyromonas gingivalis (n = 1), Porphyromonas endodontalis (n = 1), Fusobacterium nucleatum (n = 1); in nonsurvivors: Streptococcus intermedius (n = 1), Nocardia nova (n = 1), Cutibacterium acnes (n = 1), E coli (n = 2), P aeruginosa (n = 1).