Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Microbiology, Beaumont Hospital, Dublin, Ireland.
Department of Microbiology and Infection Prevention and Control, Derriford Hospital, Plymouth, UK.
J Hosp Infect. 2017 Feb;95(2):154-160. doi: 10.1016/j.jhin.2016.09.008. Epub 2016 Sep 17.
The insertion of external ventricular drains (EVDs) is necessary in some neurosurgical patients, but increases the risk of meningitis/ventriculitis. While there are well-recognized risk factors, the proportion of patients who develop meningitis/ventriculitis varies partly due to differences in definitions. A multi-disciplinary working group was established to agree definitions for EVD-associated meningitis/ventriculitis, and a surveillance system was piloted in four centres in the UK and Ireland.
Definitions were agreed based on those published previously and on clinical and microbiological criteria. An agreed dataset was developed to monitor patients after the insertion of an EVD and until the EVD was removed and the microbial aetiology was recorded.
Four neurosurgical centres participated, with 61-564 patients surveyed in each unit. The vast majority of drains were cranial. Intracranial haemorrhage was the most common indication for the EVD insertion. Between 6% and 35% of EVDs were inserted by consultants rather than junior doctors. The proportion of patients who developed meningitis/ventriculitis varied from 3% to 18% and from 4.8 to 12.7/1000 EVD-days. Coagulase-negative staphylococci were the most common microbial causes.
Routine and ongoing monitoring of patients with an EVD in situ to detect meningitis/ventriculitis presents logistical difficulties, and few units do so. This pilot study suggests that a national system of surveillance with agreed definitions and a methodology to enable unit-to-unit comparisons of EVD meningitis/ventriculitis is both necessary and feasible. This will, in turn, inform quality improvement processes leading to the minimization of infection.
在一些神经外科患者中，需要插入外部脑室引流管（EVD），但这会增加脑膜炎/脑室炎的风险。虽然存在公认的危险因素，但由于定义的差异，发生脑膜炎/脑室炎的患者比例有所不同。一个多学科工作组成立，以商定与 EVD 相关的脑膜炎/脑室炎的定义，并在英国和爱尔兰的四个中心试行监测系统。
根据先前发表的定义和临床及微生物学标准，达成了定义。开发了一个商定的数据集，用于监测插入 EVD 后的患者，直到移除 EVD 并记录微生物病因。
四个神经外科中心参与了研究，每个中心调查了 61-564 名患者。绝大多数引流管是颅内置管。颅内出血是 EVD 插入的最常见指征。6%至 35%的 EVD 由顾问医生而不是初级医生插入。发生脑膜炎/脑室炎的患者比例从 3%到 18%不等，每 1000 个 EVD 日的发生率从 4.8 到 12.7 不等。凝固酶阴性葡萄球菌是最常见的微生物病原体。
对原位 EVD 患者进行常规和持续监测以检测脑膜炎/脑室炎存在后勤方面的困难，很少有单位这样做。这项试点研究表明，建立一个具有商定定义和方法的全国性监测系统，以实现单位之间 EVD 脑膜炎/脑室炎的比较，是必要且可行的。这反过来又将为优化感染管理流程提供信息。
