Assessment of Bacterial Colonization of Intracranial Pressure Transducers: A Prospective Study
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ORIGINAL WORK
Assessment of Bacterial Colonization of Intracranial Pressure Transducers: A Prospective Study Roman Mounier1,2* , Natacha Kapandji1, Guillaume Gricourt3, David Lobo1, Christophe Rodriguez3, Stéphanie Pons1, Chakib Djediat4, Paul‑Louis Woerther5, Vincent Mellano1, Bouziane Aït‑Mamar1, Vanessa Demontant3, Biba Nebbad4, Yann Senova2,6, Melissa Arnaud1, Fabrice Cook1, Gilles Dhonneur1 and David Lebeaux7,8 © 2020 Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society
Abstract Objectives: Cerebral infections related to the presence of an intraparenchymal intracranial pressure transducer (ICPT) are rare. We assessed the incidence of ICPT-related infections and colonization using culture, molecular biology, and electron microscopy. Methods: All consecutive patients in a neurosurgical intensive care unit who had an ICPT inserted between March 2017 and February 2018 were prospectively included. Presence of colonization on the ICPTs was assessed after removal using culture, scanning electron microscopy (SEM), and next-generation sequencing (NGS). Results: Fifty-three ICPTs (53 patients), indwelling for a median of 4 (range 3–7) days, were studied. Median patient follow-up was 3 months. SEM, microbial culture, and NGS were performed for 91%, 79%, and 72% of ICPTs, respec‑ tively; 28 ICPTs (53%) were assessed using all three techniques. No patient developed ICPT-related infection. Microbial cultures were positive for two of the ICPTs (5%); colonization was identified on all ICPTs using NGS and SEM. Mature biofilm was observed on 35/48 (73%) of ICPTs. A median of 10 (8–12) operational taxonomic units were identified for each ICPT, most being of environmental origin. There was no association between biofilm maturity and antimicrobial treatment or duration of ICPT insertion. Antimicrobial treatment was associated with decreased alpha and beta-diver‑ sity (p = 0.01). Conclusions: We observed no ICPT-related cerebral infections although colonization was identified on all ICPTs using NGS and SEM. Mature biofilm was the main bacterial lifestyle on the ICPTs. Keywords: Biofilm, Colonization, Device-related infection, Intracranial pressure monitoring, DNA sequencing Introduction The use of continuous intracranial pressure (ICP) monitoring has been associated with improved outcomes in traumatic brain injury [1]. Intraventricular pressure *Correspondence: [email protected] 1 Department of Anesthesia and Surgical Intensive Care, Henri Mondor University Hospital of Paris, Paris-Est Créteil University, 51, Avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France Full list of author information is available at the end of the article
measurement using a fluid-filled catheter is considered the gold standard for ICP monitoring [2], but despite the lack of specific guidelines, intraparenchymal fiberoptic devices are now widely used because of the low frequency of complications [3–5]. ICP transducers (ICPTs) cross the various brain-protecting barriers (the scalp and the
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