A 27-year-old male with a prolonged ICU stay following a subarachnoid haemorrhage has a CSF specimen taken from his external ventricular drain (EVD).
The CSF gram stain result is shown below:
|
Parameter |
Patient Value |
Adult Normal Range |
|
Red Blood Cells |
1946 x 106/L* |
0 – 5 |
|
Polymorphs |
198 x 106/L* |
0 – 5 |
|
Mononuclear cells |
74 x 106/L* |
0 – 5 |
|
Gram stain: |
Scant gram-positive cocci. |
a) What is your assessment of the CSF result and provide a reason? (10% marks)
b) List two likely organisms commonly reported on the Gram stain in this setting.
(10% marks)
c) List two therapies you may consider based on this report. (10% marks)
a) What is your assessment of the CSF result and provide a reason? 10% marks
Ventriculitis: due to raised WCC:RCC ratio and a positive gram stain
b) List two likely organisms commonly reported on the Gram stain in this setting. 10% marks
Staphylococcus epidermidis Staphylococcus aureus
c) List 2 therapies you may consider based on this report. 10% marks
Removal of EVD / replacement
Vancomycin
After the candidate has reestablished heir composure from the grammatic assault of "What is your assessment and provide a reason", they would immediately reach the conclusion that this patient has an infected EVD. Allocating 10% of the mark to this question seems generous. The CSF is clearly infected, with a raised WCC:RCC ratio and organisms on the Gram stain.
Possible organisms are Staphylococcus aureus, Staphylococcus epidermidis or Streptococcus pyogenes.
Apart from removing the infected catheter, one would have to consider some antibiotics, which in the context of unknown sensitivities should consist of cephalosomething and vancomycin.
Oh's Intensive Care manual: Chapter 54 (pp. 597) Meningitis and encephalomyelitis by Angus M Kennedy
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