376. The microbiology and risk factors of intraventricular catheter infections in critically ill patients in a tertiary care institution a 6 year experience
Session: Poster Abstract Session: Epidemiology - Bacterial Infections
Friday, October 21, 2011
Room: Poster Hall B1
Background:Ventriculitis is a serious nosocomial complication of intraventricular catheters. The bacteriological  isolates from CSF in this setting historically have been primarily skin flora. There are also reports of microbiological shift to gram negative pathogens. Recent literature examining the microbiology is sparse in the era of drug resistant pathogens to guide empiric therapy. Such profiles may be influenced by the local flora and antibiotic usage. We report the microbiology and risk factors in critically ill patients in our neurosurgical unit.

Methods:We retrospectively analyzed 747 IVC events from January 2005 to March 2011. Ventriculitis was defined only if a positive culture was obtained from CSF around the time of insertion of IVC. Controls were with similar diagnosis with IVC but without infection.  Number of catheters, duration of catheters, length of hospitalizations, events of catheter manipulation or disconnects, CSF parameters, pathogens were recorded. Statistical analyses were performed using t test and Chi- square test.

Results:57 cases of ventriculitis and 145 controls were identified. The infection rate per 1000 catheter days was 5.68.  Concomitant bacteremias with same organism were 7%. Staphylococcus coagulase negative organisms were predominant and accounted for 27 infections (47%). 17% were Staphylococcus aureus (3 were methicillin resistant). 15 gram negative infections (26%) were isolated with 6 Enterobacter spp. Only 2 infections with vancomycin resistant Enterococcus spp.was found. Multidrug resistant gram negative organisms were absent. 8 polymicrobial infections were found. CSF parameters did not correlate with type of organism. Significant differences were found between cases and controls with respect to hospital length of stay (LOS) (40.1 vs. 21.9 days), duration of IVC (26.3 vs. 12.8 days), proportion of IVC disconnects (0.51 vs 0.12) and number of catheters per patient with p value <0.0001 in all comparisons.

Conclusion:This study demonstrates that gram positive organisms remain the predominant pathogen in ventriculitis. Significant risk factors are number and duration of catheters and disconnects. IVC infections are serious nosocomial infections that prolong LOS of hospitalizations.


Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

Mayurika Ghosh, MBBS, Medicine, University of Maryland School of Medicine, Baltimore, MD, Kirsten Lyke, MD, University of Maryland School of Medicine, Baltimore, MD and David Schreibman, MD, University of Maryland School of Medicine , Baltimore, MD

Disclosures:

M. Ghosh, None

K. Lyke, None

D. Schreibman, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.