Risk factors for infections related to external ventricular drainage in Neurosurgery Intensive Care Unit

doi:10.3877/cma.j.issn.1674-1358.03.005

Abstract

Abstract:

Objective

To investigate the infection rates and risk factors associated with external ventricular drainage (EVD) related infection in Neurosurgery Intensive Care Unit (NICU).

Methods

Total of 58 patients with EVD in NICU of Xuanwu Hospital of Capital Medical University, during 1st January 2015 to 31th December 2015 were collected. Patients and disease demographics, EVD data, antibiotic treatment, the EVD related and concomitant infection, duration of drainage and CSF sampling frequency were analyzed, retrospectively. There were 48 patients with subarachnoid hemorrhage/intracranial hemorrhage; 7 patients with intracranial tumor; 3 patients with other disease. Total of 25 patients were administrated antibiotics prophylactically.

Results

Total of 58 patients, 456 catheter-days were evaluated. The incidence of infection was 8.6% and the drain-associated infection rate was 10.9 per 1 000 catheter-days. Duration of EVD drainage (≥ 11 days; Wals = 4.8, RR = 17.3, 95%CI: 1.4-218.3, P = 0.028), CSF sampling frequency (≤ 2 days; Wals = 5.3, RR = 15.3, 95%CI : 1.5-243.7, P = 0.022) and concomitant pulmonary infection (RR = 7.8, 95%CI : 0.8-74.8, P = 0.04) were all the related risk factors.

Conclusions

The duration of drainage, CSF sampling frequency and pulmonary infection may increase the EVD related infection.

Key words: Infection, External ventricular drainage, Risk factors

Kai Wang, Yueqiao Xu, Ning Wang, Wenjin Chen, Weitao Cheng. Risk factors for infections related to external ventricular drainage in Neurosurgery Intensive Care Unit[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2017, 11(03): 228-231.

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References 24

[1]	Lwin S, Low SW, Choy DK, et al. External ventricular drain infections: successful implementation of strategies to reduce infection rate[J]. Singapore Med J,2012,53(4):255-259.
[2]	Williams TA, Leslie GD, Dobb GJ, et al. Decrease in proven ventriculitis by reducing the frequency of cerebrospinal fluid sampling from extraventricular drains[J]. J Neurosurg,2011,115(5):1040-1046.
[3]	Mayhall CG, Archer NH, Lamb VA, et al. Ventriculostomy-related infections. A prospective epidemiologic study[J]. New Engl J Med,1984,310(9):553-559.
[4]	Lozier AP, Sciacca RR, Romagnoli MF, et al. Ventriculostomy-related infections: a critical review of the literature[J]. Neurosurgery, 2002,51(1):170-181.
[5]	Kim JH, Desai NS, Ricci J, et al. Factors contributing to ventriculostomy infection[J]. World Neurosurg,2012,77(1):135-140.
[6]	Camacho EF, Boszczowski I, Basso M, et al. Infection rate and risk factors associated with infections related to external ventricular drain[J]. Infection,2011,39(1):47-51.
[7]	胡世颉, 李兵, 王冰, 等. 脑室外引流511例相关感染危险因素分析[J]. 陕西医学杂,2015,449(9):1153-1154.
[8]	Hoefnagel D, Dammers R, Ter Laak-Poort MP, et al. Risk factors for infections related to external ventricular drainage[J]. Acta Neurochir,2008,150(3):209-214.
[9]	Holloway KL, Barnes T, Choi S, et al. Ventriculostomy infections: the effect of monitoring duration and catheter exchange in 584 patients[J]. J Neurosurg,1996,85(3):419-424.
[10]	Lo CH, Spelman D, Bailey M, et al. External ventricular drain infections are independent of drain duration: an argument against elective revision[J]. J Neurosurg,2007,106(3):378-383.
[11]	Wong GK, Poon WS, Wai S, et al. Failure of regular external ventricular drain exchange to reduce cerebrospinal fluid infection: result of a randomised controlled trial[J]. J Neurol Neurosurg PS,2002,73(6):759-761.
[12]	Schade RP, Schinkel J, Roelandse FW, et al. Lack of value of routine analysis of cerebrospinal fluid for prediction and diagnosis of external drainage-related bacterial meningitis[J]. J Neurosurg,2006,104(1):101-108.
[13]	Kitchen WJ, Singh N, Hulme S, et al. External ventricular drain infection: improved technique can reduce infection rates[J]. Brit J Neurosuerg,2011,25(5):632-635.
[14]	Korinek AM, Reina M, Boch AL, et al. Prevention of external ventricular drain--related ventriculitis[J]. Acta Neurochir,2005,147(1):39-45.
[15]	Williamson RA, Phillips-Bute BG, McDonagh DL, et al. Predictors of extraventricular drain-associated bacterial ventriculitis[J]. J Crit Care,2014,29(1):77-82.
[16]	程玮涛, 徐跃峤. 神经外科肺部感染者的细菌学分析[J/CD]. 中华实验和临床感染病杂志(电子版),2015,9(2):226-228.
[17]	Clark WC, Muhlbauer MS, Lowrey R, et al. Complications of intracranial pressure monitoring in trauma patients[J]. Neurosurgery,1989,25(1):20-24.
[18]	Rafiq MF, Ahmed N, Aii S, et al. Culture and sensitivity pattern in patients with external ventricular drain infection[J]. J Ayub Med Coll,2011,23(2):118-120.
[19]	Beer R, Lackner P, Pfausler B, et al. Nosocomial ventriculitis and meningitis in neurocritical care patients[J]. J Neurol,2008,255(11):1617-1624.
[20]	Mounier R, Lobo D, Cook F, et al. From the skin to the brain: pathophysiology of colonization and infection of external ventricular drain, a prospective observational study[J]. PLoS One,2015,10(11):e0142320.
[21]	徐跃峤, 王宁, 程玮涛, 等. 神经外科重症患者革兰阴性菌致急性化脓性脑室炎的诊断和治疗[J]. 中华神经外科杂志,2015,31(10):988-991.
[22]	徐跃峤, 王宁, 程玮涛, 等. 神经外科术后多重耐药鲍曼不动杆菌脑室炎的治疗[J]. 北京医学,2015,37(11):1075-1077.
[23]	梁爱美, 邓燕婷. 脑室外引流术后脑室感染的治疗及观察研究[J]. 中国实用医,2015,10(18):116-117.
[24]	Gozal YM, Farley CW, Hanseman DJ, et al. Ventriculostomy-associated infection: a new, standardized reporting definition and institutional experience[J]. Neurocrit Care,2014,21(1),147-151.

一般资料		非感染病例（53例）	感染病例（5例）	统计量	RR（95%CI）值	P值
年龄（ ± s，岁）		56.2 ± 17.9	63.2 ± 9.0	t = 0.860	—	0.390
性别（男/女，例）		32/26	3/2	χ² = 0.052	1.2（0.2～8.0）	0.820
原发病[例（%）]
	SAH/ICH	44（75.9）	4（6.9）	χ² = 0.029	0.8（0.1～8.2）	0.860
	颅脑肿瘤	6（10.3）	1（1.7）	χ² = 0.320	2.0（0.2～21.0）	0.570
	其他	3（5.2）	0（0.0）	χ² = 0.300	1.1（1.0～1.2）	0.590
预防性使用抗菌药物[例（%）]		22（37.9）	3（5.2）	χ² = 0.640	2.1（0.3～13.7）	0.430
引流管保留时间（ ± s，d）		7.3 ± 3.9	15.2 ± 7.3	t = 3.600	—	0.001
留取脑脊液标本时间间隔（ ± s，d）		3.8 ± 2.2	1.7 ± 0.4	t =-2.000	—	0.045

一般资料		非感染病例（53例）	感染病例（5例）	统计量	RR（95%CI）值	P值
年龄（ ± s，岁）		56.2 ± 17.9	63.2 ± 9.0	t = 0.860	—	0.390
性别（男/女，例）		32/26	3/2	χ² = 0.052	1.2（0.2～8.0）	0.820
原发病[例（%）]
	SAH/ICH	44（75.9）	4（6.9）	χ² = 0.029	0.8（0.1～8.2）	0.860
	颅脑肿瘤	6（10.3）	1（1.7）	χ² = 0.320	2.0（0.2～21.0）	0.570
	其他	3（5.2）	0（0.0）	χ² = 0.300	1.1（1.0～1.2）	0.590
预防性使用抗菌药物[例（%）]		22（37.9）	3（5.2）	χ² = 0.640	2.1（0.3～13.7）	0.430
引流管保留时间（ ± s，d）		7.3 ± 3.9	15.2 ± 7.3	t = 3.600	—	0.001
留取脑脊液标本时间间隔（ ± s，d）		3.8 ± 2.2	1.7 ± 0.4	t =-2.000	—	0.045

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