Septic Surgery Unit, Department of Surgery and Anesthesiology, University Hospital Lausanne, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland.
J Infect. 2013 May;66(5):424-31. doi: 10.1016/j.jinf.2012.12.010. Epub 2013 Jan 9.
Manifestations of external ventricular drain (EVD) - associated infections overlap with those of the underlying neurosurgical conditions. We analyzed characteristics of EVD-associated infections.
We included patients aged ≥18 years with EVD-associated infections from 1997 to 2008, using modified CDC criteria for nosocomial infections. Hospital charts were reviewed retrospectively and the in-hospital outcome was evaluated.
Forty-eight patients with EVD-associated infections were included (median age, 52 years, range 20-74 years). The median EVD-indwelling time was 7 days (range, 1-39 days) and EVD-associated infection occurred 6 days after insertion (range, 1-17 days). In 23% of patients, meningitis occurred 1-10 days after EVD removal. Fever >38 °C was present in 79% of patients, but Glasgow Coma Scale (GCS) scores were reduced in only 29%, and headache, vomiting and/or neck stiffness were present in only 31%. The median cerebrospinal fluid (CSF) leukocyte count was higher at onset of EVD-associated infection than at EVD insertion (175 × 10(6)/l versus 46 × 10(6)/l, p = 0.021), but other CSF parameters did not differ significantly. The most commonly implicated organisms were coagulase-negative staphylococci (63%) and Propionibacterium acnes (15%).
Fever and increased CSF leukocytes should raise the suspicion of EVD-associated infection, which may occur up to 10 days after removal of EVD.
与外部脑室引流（EVD）相关的感染表现与基础神经外科疾病的表现重叠。我们分析了与 EVD 相关的感染的特征。
我们纳入了 1997 年至 2008 年期间年龄≥18 岁的与 EVD 相关感染的患者，使用修改后的 CDC 医院获得性感染标准。回顾性地审查了医院图表，并评估了住院期间的结局。
共纳入 48 例与 EVD 相关的感染患者（中位年龄为 52 岁，范围为 20-74 岁）。EVD 留置时间中位数为 7 天（范围为 1-39 天），EVD 相关感染发生在插入后 6 天（范围为 1-17 天）。在 23%的患者中，脑膜炎发生在 EVD 移除后 1-10 天。79%的患者有体温>38°C，但格拉斯哥昏迷评分（GCS）降低仅见于 29%的患者，头痛、呕吐和/或颈部僵硬仅见于 31%的患者。与 EVD 插入相比，EVD 相关感染发病时的脑脊液（CSF）白细胞计数更高（175×106/l 比 46×106/l，p=0.021），但其他 CSF 参数无显著差异。最常见的病原体是凝固酶阴性葡萄球菌（63%）和痤疮丙酸杆菌（15%）。
发热和 CSF 白细胞增多应提示 EVD 相关感染，感染可能发生在 EVD 移除后 10 天内。
