Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Infection. 2011 Feb;39(1):47-51. doi: 10.1007/s15010-010-0073-5. Epub 2011 Jan 25.
To describe incidence rates and risk factors associated with external ventricular drain (EVD)-related infections at a tertiary Brazilian teaching hospital.
The patient cohort consisted of all patients at a major teaching hospital in Brazil with an EVD during the period 1 April 2007 to 30 June 2008 (15 months). Patients were followed up for 30 days after catheter removal. According to the Center for Diseases Control and Prevention criteria for meningitis/ventriculitis, all of the central nervous system (CNS) infections that occurred during this period could be considered to be meningitis or ventriculitis related to EVD placement. Infection rates were calculated using different denominators, such as (1) per patient (incidence), (2) per procedure, and (3) per 1,000 catheter-days (drain-associated infection rate). Patient demographic data, medical history of underlying diseases, antibiotic prophylaxis usage, American Society of Anesthesiologists Score classification, duration of surgery and hospitalization, length of time the EVD was in place, and overall mortality were evaluated during the study period. A logistic regression model was developed to identify factors associated with infection.
A total of 119 patients, 130 EVD procedures, and 839 catheter-days were evaluated. The incidence of infection was 18.3%, the infection rate was 16.9% per procedure, and the drain-associated infection rate was 22.4 per 1,000 catheter-days; 77% of the infections were caused by Gram-negative micro-organisms. Only 75% of patients received antibiotic prophylaxis. The infection rate increased with length of the hospital stay. The length of time the catheter was in place was the only independent risk factor associated with infection (p = 0.0369).
The incidence of EVD-related infections is high in our hospital, Gram-negative micro-organisms were the most frequent causal agents identified and length of time that the catheter was in place contributed to the infection rate.
描述巴西一家三级教学医院与外部脑室引流（EVD）相关感染的发生率和相关危险因素。
该患者队列包括 2007 年 4 月 1 日至 2008 年 6 月 30 日期间在巴西一家主要教学医院接受 EVD 的所有患者（15 个月）。患者在导管拔除后 30 天内进行随访。根据疾病控制和预防中心（CDC）的脑膜炎/脑室炎标准，在此期间发生的所有中枢神经系统（CNS）感染均可被认为是与 EVD 放置相关的脑膜炎或脑室炎。使用不同的分母计算感染率，如（1）每位患者（发病率），（2）每例手术和（3）每 1000 个导管日（引流相关感染率）。在研究期间评估了患者的人口统计学数据、潜在疾病的病史、抗生素预防使用情况、美国麻醉师协会（ASA）评分分类、手术和住院时间、EVD 留置时间以及总体死亡率。建立了逻辑回归模型以确定与感染相关的因素。
共评估了 119 例患者、130 例 EVD 手术和 839 个导管日。感染发生率为 18.3%，每例手术感染率为 16.9%，每 1000 个导管日引流相关感染率为 22.4%；77%的感染由革兰氏阴性微生物引起。只有 75%的患者接受了抗生素预防。感染率随住院时间的延长而增加。导管留置时间是唯一与感染相关的独立危险因素（p=0.0369）。
我们医院 EVD 相关感染的发生率较高，革兰氏阴性微生物是最常见的病原体，导管留置时间是感染率的唯一独立危险因素。
