Scheithauer S, Bürgel U, Ryang Y-M, Haase G, Schiefer J, Koch S, Häfner H, Lemmen S
Department of Infection Control and Infectious Diseases, UK Aachen, RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
J Neurol Neurosurg Psychiatry. 2009 Dec;80(12):1381-5. doi: 10.1136/jnnp.2008.165357. Epub 2009 Mar 16.
There are currently no data available on drain associated infection occurrence related to the number of drainage days (DD), and thus drain associated infection rates. Therefore, a prospective surveillance study was conducted to determine drain associated infection rates and DD of hospital acquired external ventricular drain (EVD) and lumbar drain (LD) associated meningitis/ventriculitis in a neurosurgery and a neurological intensive care unit.
All patients admitted in 2005 and 2006 were documented. Data on age, admitting diagnosis, type and duration of drain, duration of hospital stay and occurrence of meningitis were recorded and analysed statistically.
A total of 1333 patients were included, amounting to 3023 DD. After exclusion of 15 contaminations, a total of 26 cases of meningitis were reported accounting for an overall device associated meningitis rate of 8.6 infections/1000 DD. Infections associated with LD seemed to occur more frequently (19.9/1000 DD) compared with EVD (6.3/1000 DD). The presence of intraventricular blood and previous trauma were significant risk factors for infection (p = 0.003; p = 0.04). Finally, length of stay was significantly longer in meningitis patients (p = 0.0003). Coagulase negative staphylococci were the main pathogen (56%) causing meningitis, followed by Staphylococcus aureus (25%).
To the best of the authors' knowledge, this study represents the first to provide data on EVD as well as LD associated meningitis rates calculated per 1000 DD; a parameter that is well established for other invasive devices such as central venous and urinary tract catheters. However, further prospective studies are needed to investigate the possible risk factors for meningitis.
目前尚无关于引流相关感染发生率与引流天数（DD）以及引流相关感染率之间关系的数据。因此，开展了一项前瞻性监测研究，以确定神经外科和神经重症监护病房中医院获得性外置脑室引流（EVD）和腰大池引流（LD）相关脑膜炎/脑室炎的引流相关感染率及引流天数。
记录2005年和2006年收治的所有患者情况。记录年龄、入院诊断、引流类型和时长、住院时间以及脑膜炎发生情况等数据，并进行统计学分析。
共纳入1333例患者，引流天数总计3023天。排除15例污染病例后，共报告26例脑膜炎病例，总体器械相关脑膜炎发生率为8.6例感染/1000引流天数。与EVD（6.3/1000引流天数）相比，LD相关感染似乎更频繁发生（19.9/1000引流天数）。脑室内出血和既往创伤的存在是感染的显著危险因素（p = 0.003；p = 0.04）。最后，脑膜炎患者的住院时间明显更长（p = 0.0003）。凝固酶阴性葡萄球菌是引起脑膜炎的主要病原体（56%），其次是金黄色葡萄球菌（25%）。
据作者所知，本研究首次提供了按每1000引流天数计算的EVD以及LD相关脑膜炎发生率的数据；这是一个在其他侵入性器械如中心静脉导管和尿管方面已确立的参数。然而，需要进一步开展前瞻性研究以调查脑膜炎可能的危险因素。
