Risk factors for infections related to external ventricular drainage

Hoefnagel, Daphna; Dammers, Rúben; Laak-Poort, Mariel P. Ter; Avezaat, C. J. J.

doi:10.1007/s00701-007-1458-9

Cited by 243 publications

(202 citation statements)

References 19 publications

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“…Hemorrhagic CSF, extended duration of ventriculostomy, catheter manipulation and previous craniotomy, as well as many other factors, have been proven to increase the rate of infections [1][2][3][4][5]. We have observed in our ICU patients that those with pure ICP monitors without temporary drainage are infected more frequently and sooner than those for whom CSF drainage is maintained at least temporarily.…”

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Maintaining CSF drainage at external ventricular drains may help prevent catheter-related infections

Razmkon

Bakhtazad

2009

Acta Neurochir

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Sir, We read with interest the comprehensive study by Hoefnagel et al. [1] entitled "Risk factors for infections related to external ventricular drainage". Indeed, among various forms of intracranial pressure (ICP) monitors, ventriculostomy remains unique and the most ideal [2,3]. It provides the neurosurgeon the option of therapeutic cerebrospinal fluid (CSF) drainage in addition to routine ICP monitoring [2]. The enthusiasm for the use of external ventricular drains (EVD) has unfortunately been tempered by the increased risk of ventriculomeningitis [2].Long-standing controversy exists about the risk factors of developing ventriculostomy-related infections. Hemorrhagic CSF, extended duration of ventriculostomy, catheter manipulation and previous craniotomy, as well as many other factors, have been proven to increase the rate of infections [1][2][3][4][5]. We have observed in our ICU patients that those with pure ICP monitors without temporary drainage are infected more frequently and sooner than those for whom CSF drainage is maintained at least temporarily.A few studies have pointed controversially to the same issue. Smith and Alksne [5] suggested that the use of the ventriculostomy as an EVD rather than an ICP monitor may predispose the patient to CSF infection. However, Schultz et al. [4] and Mayhall et al. [3] found no such association between CSF drainage and an increased risk of infection. Retrospective analysis of our data (unpublished) has revealed a higher rate of infection in pure ICP monitors. Such controversy may be due to the interference of confounding factors, many of which have or have not been found causative in different studies.In biologic fluid-filled systems associated with the risk of microbial contamination, obstruction to flow has been long known to be associated with stasis and infection. This is evident in the case of urinary tract infections and cholangitis. This condition does not occur in isolated body compartments such as the heart or brain ventricular system. However, when such closed systems are exposed to the threat of ascending bacterial infections in the setting of external diversion of CSF flow (EVDs), then the rules will apply. Maintenance of CSF drainage in EVDs (as opposed to pure ICP monitors) counteracts stasis, which may be effective in preventing ascending ventriculostomy-related infections.

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“…

Sir, We read with interest the comprehensive study by Hoefnagel et al [1] entitled "Risk factors for infections related to external ventricular drainage". Indeed, among various forms of intracranial pressure (ICP) monitors, ventriculostomy remains unique and the most ideal [2,3].

…”

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confidence: 99%

Maintaining CSF drainage at external ventricular drains may help prevent catheter-related infections

Razmkon

Bakhtazad

2009

Acta Neurochir

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“…(Hoefnagel et al, 2008;Kitchen et al, 2011;Korinek et al, 2005;Lwin, Low, Choy, Yeo & Chou, 2012;Muttaiyah et al, 2008;Pfisterer, Muhlbauer & Reinprechtet, 2003;Williams et al, 2011;Williamson et al, 2014).…”

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Yesterday, Today & Tomorrow: Best Practice for CSF Sampling of an EVD to Minimise Patient Risk

Crane

King²

2015

Australasian Journal of Neuroscience

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Managing raised intracranial pressure (ICP) with the use of an external ventricular drain (EVD) is a common occurrence in a neurosurgical setting. A central role of the neuroscience nurse in managing that EVD is to monitor the patient for signs and symptoms of infection otherwise known as ventriculitis. Cerebrospinal fluid (CSF) sampling from an EVD has historically been completed as a daily routine specimen to monitor for any signs of infection. However, in more recent times there has been evidence to suggest that specimens should only be collected when infection or ventriculitis is suspected to minimise the interruption of the closed system. Different practices have been identified related to the frequency of sampling, the best solution for decontamination of the sampling site/ port and preferable port for obtaining the specimen. Our aim was to complete an integrative literature review. Medline Complete and CINAHL were searched and articles were screened. Nine articles were used to form the integrated review. The main findings were collated and found that daily sampling is no longer recommended. The proximal port was the most popular choice for sampling. Decontaminating solutions used for accessing an EVD varied with no evidence to support the choice of solution. Findings of the majority of papers were focussed on sampling frequency and other associated ways to minimise infection rather than choice of sampling site or the use of specific decontaminating solutions.

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“…Nozokomiyal SSS infeksiyonları için en önemli risk faktörü nöroşirürjik operasyonlar ve sonrasında hastada devam eden invazif araçla-rın özellikle de EVD kateterinin bulunması-dır (8,10) . Yapılan çalışmalarda EVD kateter ilişkili infeksiyon insidansı % 2-27 arasındaki oranlarda bildirilmektedir (1,8) .…”

Section: Discussionunclassified

“…Yapılan çalışmalarda EVD kateter ilişkili infeksiyon insidansı % 2-27 arasındaki oranlarda bildirilmektedir (1,8) . EVD kateter varlığının infeksiyon gelişme süresini kısalttığı, yapılan çalışmalarda 11 gün üzerinde kalan kateterlerde infeksiyon oranının 4 kat arttığı gösterilmiştir (8) . Çalışmamızda da 48 hastanın 33'ünde (% 69) EVD kateteri bulunmaktaydı ve EVD kateteri varlığı mortaliteyi 11 kat arttırmaktaydı.…”

Section: Discussionunclassified

Factors Associated with Mortality in Nosocomial Central Nervous System Infections

Dizbay¹,

Tunçcan²,

Arman³

et al. 2011

ANKEM Derg

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Risk factors for infections related to external ventricular drainage

Cited by 243 publications

References 19 publications

Maintaining CSF drainage at external ventricular drains may help prevent catheter-related infections

Maintaining CSF drainage at external ventricular drains may help prevent catheter-related infections

Yesterday, Today & Tomorrow: Best Practice for CSF Sampling of an EVD to Minimise Patient Risk

Factors Associated with Mortality in Nosocomial Central Nervous System Infections

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