Background and ObjectivesExternal ventricular drainage (EVD) is one of the most commonly performed neurosurgical procedures, but EVD-related infection constitutes a significant health concern. Yet, little consensus identifies the risk factors for the development of EVD-related infection. Therefore, we performed a meta-analysis to systematically summarize existing evidence on the incidence and risk factors for EVD-related infection.MethodsPubMed, Embase, and the Cochrane Library databases from database inception to February 28, 2022, were searched for all studies investigating the incidence and risk factors for EVD-related infection. Data were assessed by R-4.2.0 software. The meta-analysis was used to calculate pooled odds ratios (OR) and 95% confidence intervals (CI).ResultsA total of 48 studies were included. Among the 29 factors analyzed, statistically significant risk factors were subarachnoid hemorrhage(SAH)/intraventricular hemorrhage(IVH) (OR = 1.48, 95% CI = 1.20–1.82,p< 0.001), concomitant systemic infection (OR = 1.90, 95% CI = 1.34–2.70,p< 0.001), other neurosurgical procedures (OR = 1.76, 95% CI = 1.02–3.04,p= 0.041), change of catheter (OR = 5.05, 95% CI = 3.67–6.96,p< 0.001), bilateral EVDs (OR = 2.25, 95% CI = 1.03–4.89,p= 0.041), (cerebrospinal fluid) CSF leak (OR = 3.19, 95% CI = 2.12–4.81,p< 0.001) and duration of EVD >7 days (OR = 4.62, 95% CI = 2.26–9.43,p< 0.001). The use of silver-coated catheters (OR = 0.57, 95% CI = 0.38–0.87,p= 0.008) and antibiotic-impregnated catheters (OR = 0.60, 95% CI = 0.41–0.88,p= 0.009) might help reduce the risk of infection. No significant difference was indicated in studies evaluating factors like diabetes mellitus (OR = 1.25, 95% CI = 0.90–1.75,p= 0.178), steroids used (OR = 1.52, 95% CI = 0.96–2.4,p= 0.074), prophylactic antibiotics(OR = 0.87, 95% CI = 0.66–1.14,p= 0.308).DiscussionThe meta-analysis of various relevant factors in the onset of EVD-related infection in patients submitted to EVD enabled us to establish a more probable profile of the patients who are more likely to develop it during the treatment.