Risk Factors for External Ventricular Drainage–Related Infection

Abstract

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.

Infections Associated with Medtronic Duet External Ventricular Drains — Rhode Island Hospital, Providence, Rhode Island, January 2023–January 2024

“…Approximately 25,000 EVDs are placed annually, making EVD insertion among the most common and important lifesaving neurosurgical procedures performed in the United States ( 3 ). Unintentional disconnections and breaks or fractures (breaks) of the EVD or the connecting drainage system tubing can result in CSF leakage and contamination of the EVD system, increasing the risk for EVD-associated infections, including meningitis and ventriculitis ( 4 , 5 ).…”