Shekhar H, Kalsi P, Dambatta S, Strachan R
a Department of Neurosurgery , Western General Hospital , Edinburgh , UK ;
b Department of Neurosurgery , James Cook University Hospital , Middlesbrough , UK.
Br J Neurosurg. 2016;30(1):64-9. doi: 10.3109/02688697.2015.1096903. Epub 2015 Oct 15.
External ventriculostomy-related infection (VRI) of cerebrospinal fluid (CSF) is a source of significant morbidity and mortality. In previous trials, antibiotic-impregnated ventricular catheters have been associated with lower incidence of CSF infections. We undertook this retrospective observational study to evaluate whether the introduction of antibiotic-impregnated external ventricular drains (EVDs) in 2004 has decreased VRI in our neurosurgical unit.
One hundred and fifteen patients underwent insertion of EVDs from January 2000 to March 2008. Data were collected for 99 patients with a total of 146 EVD insertions. The parameters studied were age, gender, ASA score, seniority of the surgeon, significant medical history, presence of trauma, concurrent surgeries, revisional surgery, use of peri-operative systemic antibiotic, use of antibiotic-impregnated external ventricular catheter, tunnelling of the catheter, duration of drainage and VRIs.
Eleven patients developed new VRI (12%). Analysis comparing infection incidence for various co-morbidities shows that systemic sepsis was associated with higher infection rates (p = 0.037). Revisional surgery (p = 0.036) and longer duration of catheterization (p = 0.001) were also found to be associated with VRI. The Standard catheters and the antibiotic-impregnated catheters had similar infection rates. The antibiotic-impregnated catheters tended to be infection-free for longer but these differences were not statistically significant. The duration of catheterization was significantly higher for the antibiotic-impregnated catheter group. In both groups, the majority of infections were caused by Gram-positive bacteria.
Our study demonstrates that there was no statistically significant difference in the infection rates for the Standard and antibiotic-impregnated external ventriculostomy catheters. The duration of catheterization was significantly higher for the Antibiotic-impregnated catheter group. The antibiotic-impregnated catheter infections tended to occur later as compared with the Standard catheter group.
脑脊液（CSF）外引流相关感染（VRI）是导致严重发病和死亡的一个原因。在以往的试验中，抗生素浸渍脑室导管与脑脊液感染发生率较低相关。我们进行了这项回顾性观察研究，以评估2004年引入抗生素浸渍的外引流管（EVD）是否降低了我们神经外科的VRI发生率。
2000年1月至2008年3月期间，115例患者接受了EVD置入。收集了99例患者共146次EVD置入的数据。研究的参数包括年龄、性别、美国麻醉医师协会（ASA）评分、外科医生资历、重要病史、是否存在创伤、同期手术、翻修手术、围手术期全身抗生素的使用、抗生素浸渍外引流管的使用、导管隧道置入、引流持续时间和VRI。
11例患者发生了新的VRI（12%）。对各种合并症感染发生率的分析表明，全身脓毒症与较高的感染率相关（p = 0.037）。还发现翻修手术（p = 0.036）和较长的置管时间（p = 0.001）与VRI相关。标准导管和抗生素浸渍导管的感染率相似。抗生素浸渍导管的无感染时间往往更长，但这些差异无统计学意义。抗生素浸渍导管组的置管时间明显更长。两组中，大多数感染由革兰氏阳性菌引起。
我们的研究表明，标准外引流管和抗生素浸渍外引流管的感染率在统计学上没有显著差异。抗生素浸渍导管组的置管时间明显更长。与标准导管组相比，抗生素浸渍导管感染往往发生得更晚。
