Discipline of Emergency Medicine, School of Primary, Aboriginal and Rural Health Care, Nedlands, Australia.
J Neurosurg. 2011 Nov;115(5):1040-6. doi: 10.3171/2011.6.JNS11167. Epub 2011 Jul 29.
Ventriculitis associated with extraventricular drains (EVD) increases rates of morbidity and mortality as well as costs. Surveillance samples of CSF are taken routinely from EVD, but there is no consensus on the optimum frequency of sampling. The goal of this study was to assess whether the incidence of ventriculitis changed when CSF sampling frequency was reduced once every 3 days.
After receiving institutional ethics committee approval for their project, the authors compared a prospective sample of EVD-treated patients (admitted 2008-2009) and a historical comparison group (admitted 2005-2007) at two tertiary hospital ICUs. A broad definition of ventriculitis included suspected ventriculitis (that is, treated with antibiotics for ventriculitis) and proven ventriculitis (positive CSF culture). Adult ICU patients with no preexisting neurological infection were enrolled in the study. After staff was provided with an education package, sampling of CSF was changed from daily to once every 3 days. All other management of the EVD remained unchanged. More frequent sampling was permitted if clinically indicated during the third daily sampling phase.
Two hundred seven patients were recruited during the daily sampling phase and 176 patients when sampling was reduced to once every 3 days. The Acute Physiology and Chronic Health Evaluation (APACHE) II score was lower for the daily sampling group than for the every-3rd-day group (18.6 vs 20.3, respectively; p < 0.01), but there was no difference in mean age (47 and 45 years, respectively; p = 0.14), male or female sex (61% and 59%, respectively; p = 0.68), or median EVD duration in the ICU (4.9 and 5.8 days, respectively; p = 0.14). Most patients were admitted with subarachnoid hemorrhage (42% in the daily group and 33% in the every-3rd-day group) or traumatic head injuries (29% and 36%, respectively). The incidence of ventriculitis decreased from 17% to 11% overall and for proven ventriculitis from 10% to 3% once sampling frequency was reduced. Sampling of CSF once every 3 days was independently associated with ventriculitis (OR 0.44, 95% CI 0.22-0.88, p = 0.02).
Reducing the frequency of CSF sampling to once every 3 days was associated with a significant decrease in the incidence of ventriculitis. The authors suggest that CSF sampling should therefore be performed once every 3 days in the absence of clinical indicators of ventriculitis. Reducing frequency of CSF sampling from EVDs decreased proven ventriculitis.
与脑室引流管（EVD）相关的脑室炎会增加发病率、死亡率和医疗成本。EVD 常规采集脑脊液监测样本，但目前尚无关于最佳采样频率的共识。本研究旨在评估当脑脊液采样频率从每天一次减少至每 3 天一次时，脑室炎的发生率是否会发生变化。
在获得机构伦理委员会批准后，作者比较了两个三级医院 ICU 中一组前瞻性的 EVD 治疗患者（2008-2009 年入院）和一组历史对照组（2005-2007 年入院）。脑室炎的广泛定义包括疑似脑室炎（即因脑室炎接受抗生素治疗）和确诊的脑室炎（脑脊液培养阳性）。研究纳入无先前神经感染的成人 ICU 患者。在为医护人员提供一整套教育资料后，将 CSF 采样从每天一次改为每 3 天一次。EVD 的所有其他管理均保持不变。如果在第三日的每日采样阶段临床需要，可增加采样频率。
在每天采样组中招募了 207 例患者，在每 3 天采样组中招募了 176 例患者。与每日采样组相比，每 3 天采样组的急性生理学和慢性健康评估（APACHE）Ⅱ评分较低（分别为 18.6 和 20.3；p<0.01），但平均年龄（分别为 47 岁和 45 岁；p=0.14）、男性或女性比例（分别为 61%和 59%；p=0.68）或 ICU 内 EVD 持续时间中位数（分别为 4.9 天和 5.8 天；p=0.14）均无差异。大多数患者因蛛网膜下腔出血（每日组 42%，每 3 天组 33%）或创伤性脑损伤（每日组 29%，每 3 天组 36%）入院。总体脑室炎发生率从 17%降至 11%，确诊脑室炎发生率从 10%降至 3%。每 3 天采样一次与脑室炎有关（比值比 0.44，95%置信区间 0.22-0.88，p=0.02）。
将 CSF 采样频率减少至每 3 天一次与脑室炎发生率的显著下降相关。作者建议在无脑室炎临床指征的情况下，应每 3 天进行一次 CSF 采样。减少 EVD 中的 CSF 采样频率可降低确诊的脑室炎发生率。
