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Risk factors and outcomes associated with external ventricular drain infections

BACKGROUND: Insertion of an external ventricular drain (EVD) is a common neurosurgical procedure which may lead to serious complications including infection. Some risk factors associated with EVD infection are well established. Others remain less certain, including specific indications for placement...

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Autores principales: Walek, Konrad W., Leary, Owen P., Sastry, Rahul, Asaad, Wael F., Walsh, Joan M., Horoho, Jean, Mermel, Leonard A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cambridge University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9753061/
https://www.ncbi.nlm.nih.gov/pubmed/35471129
http://dx.doi.org/10.1017/ice.2022.23
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author Walek, Konrad W.
Leary, Owen P.
Sastry, Rahul
Asaad, Wael F.
Walsh, Joan M.
Horoho, Jean
Mermel, Leonard A.
author_facet Walek, Konrad W.
Leary, Owen P.
Sastry, Rahul
Asaad, Wael F.
Walsh, Joan M.
Horoho, Jean
Mermel, Leonard A.
author_sort Walek, Konrad W.
collection PubMed
description BACKGROUND: Insertion of an external ventricular drain (EVD) is a common neurosurgical procedure which may lead to serious complications including infection. Some risk factors associated with EVD infection are well established. Others remain less certain, including specific indications for placement, prior neurosurgery, and prior EVD placement. OBJECTIVE: To identify risk factors for EVD infections. METHODS: We reviewed all EVD insertions at our institution from March 2015 through May 2019 following implementation of a standardized infection control protocol for EVD insertion and maintenance. Cox regression was used to identify risk factors for EVD infections. RESULTS: 479 EVDs placed in 409 patients met inclusion criteria, and 9 culture-positive infections were observed during the study period. The risk of infection within 30 days of EVD placement was 2.2% (2.3 infections/1,000 EVD days). Coagulase-negative staphylococci were identified in 6 of the 9 EVD infections). EVD infection led to prolonged length of stay post–EVD-placement (23 days vs 16 days; P = .045). Cox regression demonstrated increased infection risk in patients with prior brain surgery associated with cerebrospinal fluid (CSF) diversion (HR, 8.08; 95% CI, 1.7–39.4; P = .010), CSF leak around the catheter (HR, 21.0; 95% CI, 7.0–145.1; P = .0007), and insertion site dehiscence (HR, 7.53; 95% CI, 1.04–37.1; P = .0407). Duration of EVD use >7 days was not associated with infection risk (HR, 0.62; 95% CI, 0.07–5.45; P = .669). CONCLUSION: Risk factors associated with EVD infection include prior brain surgery, CSF leak, and insertion site dehiscence. We found no significant association between infection risk and duration of EVD placement.
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spelling pubmed-97530612022-12-21 Risk factors and outcomes associated with external ventricular drain infections Walek, Konrad W. Leary, Owen P. Sastry, Rahul Asaad, Wael F. Walsh, Joan M. Horoho, Jean Mermel, Leonard A. Infect Control Hosp Epidemiol Original Article BACKGROUND: Insertion of an external ventricular drain (EVD) is a common neurosurgical procedure which may lead to serious complications including infection. Some risk factors associated with EVD infection are well established. Others remain less certain, including specific indications for placement, prior neurosurgery, and prior EVD placement. OBJECTIVE: To identify risk factors for EVD infections. METHODS: We reviewed all EVD insertions at our institution from March 2015 through May 2019 following implementation of a standardized infection control protocol for EVD insertion and maintenance. Cox regression was used to identify risk factors for EVD infections. RESULTS: 479 EVDs placed in 409 patients met inclusion criteria, and 9 culture-positive infections were observed during the study period. The risk of infection within 30 days of EVD placement was 2.2% (2.3 infections/1,000 EVD days). Coagulase-negative staphylococci were identified in 6 of the 9 EVD infections). EVD infection led to prolonged length of stay post–EVD-placement (23 days vs 16 days; P = .045). Cox regression demonstrated increased infection risk in patients with prior brain surgery associated with cerebrospinal fluid (CSF) diversion (HR, 8.08; 95% CI, 1.7–39.4; P = .010), CSF leak around the catheter (HR, 21.0; 95% CI, 7.0–145.1; P = .0007), and insertion site dehiscence (HR, 7.53; 95% CI, 1.04–37.1; P = .0407). Duration of EVD use >7 days was not associated with infection risk (HR, 0.62; 95% CI, 0.07–5.45; P = .669). CONCLUSION: Risk factors associated with EVD infection include prior brain surgery, CSF leak, and insertion site dehiscence. We found no significant association between infection risk and duration of EVD placement. Cambridge University Press 2022-12 2022-04-26 /pmc/articles/PMC9753061/ /pubmed/35471129 http://dx.doi.org/10.1017/ice.2022.23 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Walek, Konrad W.
Leary, Owen P.
Sastry, Rahul
Asaad, Wael F.
Walsh, Joan M.
Horoho, Jean
Mermel, Leonard A.
Risk factors and outcomes associated with external ventricular drain infections
title Risk factors and outcomes associated with external ventricular drain infections
title_full Risk factors and outcomes associated with external ventricular drain infections
title_fullStr Risk factors and outcomes associated with external ventricular drain infections
title_full_unstemmed Risk factors and outcomes associated with external ventricular drain infections
title_short Risk factors and outcomes associated with external ventricular drain infections
title_sort risk factors and outcomes associated with external ventricular drain infections
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9753061/
https://www.ncbi.nlm.nih.gov/pubmed/35471129
http://dx.doi.org/10.1017/ice.2022.23
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