Gram-Negative ventriculostomy-associated infections predict shunt dependency in stroke diagnoses and other brain injuries

Santiago R. Unda, Hamad Mousa, Kevin Labagnara, Jessie Birnbaum, Neranjan De Silva, Megan Wong, Aleka N. Scoco, Neil Haranhalli, David J. Altschul

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Several predictors have been studied for shunt dependency after stroke and other brain injuries. However, little is known about the association between ventriculostomy-associated infections (VAIs) and impaired cerebrospinal fluid (CSF) outflow. Moreover, gram-negative (GN) VAIs induce a potent neuroinflammatory process and are clinically challenging to treat. OBJECTIVE: To assess if GN-VAIs predict ventriculoperitoneal shunt (VPS) dependency. METHODS: Retrospective analysis of postprocedure infection rates was performed in 586 patients with external ventricle drainage (EVD) placed on site between 2012 and 2018. We collected sex, age, stroke and nonstroke related, location of EVD placement, type of hospital, EVD duration, and EVD exchange. RESULTS: Among 586 patients requiring an EVD, 55 developed a VAI. Most were caused by gram-positive (GP) pathogens (61.8%). A total of 120 patients required a conversion from EVD to VPS. Patients with VAIs had higher rates of VPS placement (49.09% vs 17.65%, P <. 001), whereas patients with GN-VAIs had significantly higher rates of EVD conversion to VPS (77.78% vs 35.29%, P =. 012) compared with GP-VAIs. The multivariate analysis showed that GN-VAIs were an independent predictor for shunt dependency (odds ratio = 12.896; 95% CI 3.407-48.82, P <. 001). In receiver operating characteristics analysis, those less than 44.5 yr of age and more than 12 d of EVD duration were identified as the best cutoff values to discriminate the development of GN-VAI. CONCLUSION: Patients who experience a GN VAI are in greater risk of impaired CSF outflow, thus requiring VPS placement.

Original languageEnglish (US)
Pages (from-to)462-468
Number of pages7
JournalOperative Neurosurgery
Issue number5
StatePublished - May 1 2021


  • Gram-negative
  • Stroke
  • Ventriculostomy-associated infection

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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