Predictors of ventriculostomy infection in a large single-center cohort

Sweid, Ahmad; Weinberg, Joshua; Abbas, Rawad; Naamani, Kareem El; Tjoumakaris, Stavropoula; Wamsley, Christine E; Mann, Erica; Neely, Christopher; Head, Jeffery; Nauheim, David; Hauge, Julie; Gooch, M. Reid; Herial, Nabeel; Zarzour, Hekmat; Alexander, Tyler; Missios, Symeon; Hasan, David; Chalouhi, Nohra; Rosenwasser, Robert H.; Jabbour, Pascal

doi:10.3171/2020.2.jns192051

Cited by 13 publications

(6 citation statements)

References 33 publications

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“…In the current study, the numbers of CSF collections before VAI was identi ed between the VAI group and the non-VAI group were not statistically different (3.0 vs. 3.5, P = 0.337), consistent with a recent study by Sweid et al who demonstrated that routine CSF collection and CSF collection when needed were not associated with VAI. [11] Our study suggests that CSF collection itself may not be a signi cant risk factor for VAI, provided that the closed CSF drainage system is not breached.…”

Section: Patient and Procedures Characteristicsmentioning

confidence: 62%

Predictors and microbiology of ventriculostomy-associated infections: A retrospective study of 216 patients

Kim

Lee

et al. 2021

Preprint

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BACKGROUND AND PURPOSE: Ventriculostomy-associated infection (VAI) is a serious complication of external ventricular drainage (EVD). Infection rates and risk factors are variable in the literature due to heterogeneity of EVD procedures and management. This study aimed to investigate the incidence of VAI and its associated factors in two institutions with identical EVD procedural and management protocols.METHODS: The authors reviewed the medical records of patients older than 18 years who received EVD placements between January 2015 and December 2020 in two institutions under a single healthcare system. RESULTS: A total of 216 patients with 328 catheters was included for analysis. Twenty-three VAIs were identified, a 10.6% VAI rate. VAI was associated with a shorter duration of first EVD (9.7 days vs. 11.8 days, P = 0.018), a longer total EVD duration (28.0 days vs. 16.1 days, P < 0.001), a longer procedural time (72 minutes vs. 40 minutes, P < 0.001), catheterization at non-Kocher’s points (34.7% vs. 12.5%, P = 0.010), cerebrospinal fluid (CSF) leak (8.7% vs. 1.6%, P = 0.030), craniotomy (87.0% vs. 61.7%, P = 0.020), and other systemic infections (30.4% vs. 9.3%, P = 0.012). On multivariate analysis, the first EVD duration (OR = 0.095, P < 0.001), total EVD duration (OR 1.128, P < 0.001), EVD placement at non-Kocher’s point (OR 4.545, P = 0.012), and other systemic infections (OR = 5.117, P = 0.024) were associated independently with VAI. There was no statistical difference in VAI rate between patients with or without prophylactic EVD exchange at 14 days (6.8% vs. 12.6%, P = 0.247).CONCLUSIONS: Concomitant systemic infection and placement of an EVD catheter at a non-Kocher’s point were independently associated with VAI. Prophylactic EVD exchange at 14 days did not lower VAI rate.

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Section: Patient and Procedures Characteristicsmentioning

confidence: 62%

Predictors and microbiology of ventriculostomy-associated infections: A retrospective study of 216 patients

Kim

Lee

et al. 2021

Preprint

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“…This figure is significantly higher than figures quoted in literature from centers in first-world countries that utilized standard EVD devices. These ranged between 3 and 10% [17][18][19][20][21]. The reason for the high infection rates may be related to the design of the improvised drains themselves.…”

Section: Discussionmentioning

confidence: 99%

A Scoping Review of the Use of Improvised External Ventricular Drains in Africa

Jesuyajolu¹,

Aremu²,

Olukoya³

et al. 2022

Cureus

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Poor access to neurosurgical equipment is one of the problems limiting service delivery in Africa. Improvised surgical devices have long been used in Africa as replacements for high-cost standard versions. In this study, we aimed to see if improvised external ventricular drains (EVD) are being used, how these devices are made, and what their outcomes are. The PRISMA extension for scoping reviews was used in conducting this study. A search was conducted from inception to July 2022. PubMed, Ovid Embase, and African Journal Online were searched. Three studies were identified and used. The methods of making the EVD devices were compared and the incidence proportions of improvised EVD-related infections were calculated. The standard ventricular catheter was replaced by cheaper alternatives like a size 6/8 feeding tube or a 14-gauge central line catheter. The connecting tube had low-cost alternatives, and in a study, was replaced by a fluid infusion set. Aggregated outcomes from the three identified studies show that just over half of the sample survived post-EVD insertion (54%). The incidence proportion of EVD-related infections was 24%. This study describes the experience of African centers with an improvised version of the EVD devices and their outcomes. This will serve as a baseline for more research into the use of improvised EVD devices in low-resource settings.

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“…Reported rates of EVD associated infections range between 0 and 23.2% (1)(2)(3)(4)(5) and lead to prolonged hospitalization of patients at intensive care units (ICU) (6). The number of studies investigating possible risk factors that lead to EVD associated infections are sparse and show divergent results (5)(6)(7)(8)(9)(10)(11). Indication for EVD insertion, multiple catheters used, duration of catheterization, CSF sampling frequency, and co-infection are usually described as the most common risk factors leading to EVD associated infections (5)(6)(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

“…Indication for EVD insertion, multiple catheters used, duration of catheterization, CSF sampling frequency, and co-infection are usually described as the most common risk factors leading to EVD associated infections (5)(6)(7)(8)(9). However, comparison between studies is often complicated due to different definitions of EVD associated infections (2, 3,[10][11][12].…”

Section: Introductionmentioning

confidence: 99%

“…Only a few historical studies have included the pathogen into their definition of EVD associated infection ( 4 , 18 ), with recent neurosurgical studies neglecting this important factor into their definitions ( 3 , 10 , 11 , 19 ). Non-neurosurgical studies have shown a variable pathogenicity between different bacterial species, especially in coagulase-negative staphylococci (CoNS) ( 20 , 21 ), which is the predominant bacterial species causing EVD associated infections ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors Promoting External Ventricular Drain Infections in Adult Neurosurgical Patients at the Intensive Care Unit—A Retrospective Study

et al. 2021

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Objectives: Multiple risk factors have been described to be related to external ventricular drain (EVD) associated infections, with results varying between studies. Former studies were limited by a non-uniform definition of EVD associated infection, thus complicating a comparison between studies. In this regard, we assessed risk factors promoting EVD associated infections and propose a modified practice-oriented definition of EVD associated infections.Methods: We performed a retrospective, single-center study on patients who were treated with an EVD, at the neurosurgical intensive care unit (ICU) at a tertiary center between 2008 and 2019. Based on microbiological findings and laboratory results, patients were assigned into an infection and a non-infection group. Patient characteristics and potential risk factors were compared between the two groups (p < 0.05). Receiver operating characteristics (ROC) for significant clinical, serum laboratory and cerebrospinal fluid (CSF) parameters were calculated.Results: In total, 396 patients treated with an EVD were included into the study with a mean age of 54.3 (range: 18–89) years. EVD associated infections were observed in 32 (8.1%) patients. EVD insertion at another hospital (OR 3.86), and an increased CSF sampling frequency of more than every third day (OR 12.91) were detected as major risk factors for an EVD associated infection. The indication for EVD insertion, surgeon's experience, the setting of EVD insertion (ICU vs. operating room) and the operating time did not show any significant differences between the two groups. Furthermore, ROC analysis showed that clinical, serum laboratory and CSF parameters did not provide specific prediction of EVD associated infections (specificity 44.4%). This explains the high overtreatment rate in our cohort with the majority of our patients who received intrathecal vancomycin (63.3%), having either negative microbiological results (n = 12) or were defined as contaminations (n = 7).Conclusions: Since clinical parameters and blood analyzes are not very predictive to detect EVD associated infections in neurosurgical patients, sequential but not too frequent microbiological and laboratory analysis of CSF are still necessary. Furthermore, we propose a uniform classification for EVD associated infections to allow comparability between studies and to sensitize the treating physician in determining the right treatment.

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Predictors of ventriculostomy infection in a large single-center cohort

Cited by 13 publications

References 33 publications

Predictors and microbiology of ventriculostomy-associated infections: A retrospective study of 216 patients

Predictors and microbiology of ventriculostomy-associated infections: A retrospective study of 216 patients

A Scoping Review of the Use of Improvised External Ventricular Drains in Africa

Risk Factors Promoting External Ventricular Drain Infections in Adult Neurosurgical Patients at the Intensive Care Unit—A Retrospective Study

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