Journal Article

Prospective, multicentre study of external ventricular drainage-related infections in the UK and Ireland

Poon, Michael Tin-Chung, Kandasamy, Jothy, Brennan, Paul M, Jenkinson, Michael D, Chari, Aswin, Abdulla, Mutwakil A H, Glancz, Laurence J, Joannides, Alexis J, Duddy, John, Bayston, Roger, Gray, William P, Jamjoom, Aimun A B, Hutchinson, Peter J, Mallucci, Conor L, Zaben, Malik, Ahmed, Aminul I, Bulters, Diederik O, Roach, Joy, Kolias, Angelos G, Solth, Anna

2018

Overview

ObjectivesExternal ventricular drain (EVD) insertion is a common neurosurgical procedure. EVD-related infection (ERI) is a major complication that can lead to morbidity and mortality. In this study, we aimed to establish a national ERI rate in the UK and Ireland and determine key factors influencing the infection risk.MethodsA prospective multicentre cohort study of EVD insertions in 21 neurosurgical units was performed over 6 months. The primary outcome measure was 30-day ERI. A Cox regression model was used for multivariate analysis to calculate HR.ResultsA total of 495 EVD catheters were inserted into 452 patients with EVDs remaining in situ for 4700 days (median 8 days; IQR 4–13). Of the catheters inserted, 188 (38%) were antibiotic-impregnated, 161 (32.5%) were plain and 146 (29.5%) were silver-bearing. A total of 46 ERIs occurred giving an infection risk of 9.3%. Cox regression analysis demonstrated that factors independently associated with increased infection risk included duration of EVD placement for ≥8 days (HR=2.47 (1.12–5.45); p=0.03), regular sampling (daily sampling (HR=4.73 (1.28–17.42), p=0.02) and alternate day sampling (HR=5.28 (2.25–12.38); p<0.01). There was no association between catheter type or tunnelling distance and ERI.ConclusionsIn the UK and Ireland, the ERI rate was 9.3% during the study period. The study demonstrated that EVDs left in situ for ≥8 days and those sampled more frequently were associated with a higher risk of infection. Importantly, the study showed no significant difference in ERI risk between different catheter types.

• Publisher: BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Adolescent / Adult / Age / Aged / Aged, 80 and over / Antibiotics / Antimicrobial agents / Catheter-Related Infections - epidemiology / Catheter-Related Infections - microbiology / Catheters / Catheters, Indwelling / Cerebral Ventricles / Child / Child, Preschool / Collaboration / Data collection / Epidemiology / Etiology / Female / Humans / Infant / Infant, Newborn / Infections / Ireland - epidemiology / Male / Middle Aged / Neurosurgery / Neurosurgical Procedures / Patients / Postoperative Complications - epidemiology / Postoperative Complications - microbiology / Proportional Hazards Models / Prospective Studies / Psychiatry / Staphylococcal Infections - epidemiology / Studies / United Kingdom - epidemiology / Ventriculostomy / Young Adult