Jamjoom, A.A.B., Joannides, A., Poon, M., Chari, A., Zaben, M., Abdullah, M.A.H., Roach, J., Glancz, L.J., Solth, A., Duddy, J., Brennan, P.M., Bayston, Roger, Bulters, D.O., Mallucci, C., Jenkinson, M.D., Gray, W.P., Kandamsay, J., Hutchinson, P.J., Kolias, A.G. and Ahmed, A.I.
(2018)
A prospective, multicentre study of external ventricular drainage-related infections in the United Kingdom and Ireland.
Journal of Neurology, Neurosurgery and Psychiatry, 89
.
pp. 120-126.
ISSN 1468-330X
Full text not available from this repository.
Abstract
Objectives
External 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 United Kingdom (UK) and Ireland and determine key factors influencing the infection risk.
Methods
A prospective multi-centre 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 Hazard Ratios (HR).
Results
A total of 495 EVD catheters were inserted into 452 patients with EVDs remaining in-situ for 4700 days (median 8 days; interquartile range 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.
Conclusions
In 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.
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