Department of Clinical Neuroscience, Western General Hospital, Edinburgh, UK.
Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke's Hospital, Cambridge, UK.
J Neurol Neurosurg Psychiatry. 2018 Feb;89(2):120-126. doi: 10.1136/jnnp-2017-316415. Epub 2017 Oct 25.
External ventricular drain (EVD) insertion is a common neurosurgical procedure. EVD-related infection (ERI) is a major complication that can lead to morbidity and mortality. In this study, we aimed to establish a national ERI rate in the UK and Ireland and determine key factors influencing the infection risk.
A prospective multicentre cohort study of EVD insertions in 21 neurosurgical units was performed over 6 months. The primary outcome measure was 30-day ERI. A Cox regression model was used for multivariate analysis to calculate HR.
A total of 495 EVD catheters were inserted into 452 patients with EVDs remaining in situ for 4700 days (median 8 days; IQR 4-13). Of the catheters inserted, 188 (38%) were antibiotic-impregnated, 161 (32.5%) were plain and 146 (29.5%) were silver-bearing. A total of 46 ERIs occurred giving an infection risk of 9.3%. Cox regression analysis demonstrated that factors independently associated with increased infection risk included duration of EVD placement for ≥8 days (HR=2.47 (1.12-5.45); p=0.03), regular sampling (daily sampling (HR=4.73 (1.28-17.42), p=0.02) and alternate day sampling (HR=5.28 (2.25-12.38); p<0.01). There was no association between catheter type or tunnelling distance and ERI.
In the UK and Ireland, the ERI rate was 9.3% during the study period. The study demonstrated that EVDs left in situ for ≥8 days and those sampled more frequently were associated with a higher risk of infection. Importantly, the study showed no significant difference in ERI risk between different catheter types.
脑室外引流（EVD）置管是一种常见的神经外科手术。EVD 相关感染（ERI）是一种主要的并发症，可导致发病率和死亡率。本研究旨在确定英国和爱尔兰的 ERI 发生率，并确定影响感染风险的关键因素。
对 21 个神经外科单位进行了为期 6 个月的前瞻性多中心 EVD 置管队列研究。主要结局指标为 30 天 ERI。采用 Cox 回归模型进行多变量分析，计算 HR。
共插入 495 根 EVD 导管，452 例患者 EVD 留置 4700 天（中位数 8 天；IQR 4-13）。插入的导管中，188 根（38%）为抗生素浸渍，161 根（32.5%）为普通导管，146 根（29.5%）为含银导管。共发生 46 例 ERI，感染风险为 9.3%。Cox 回归分析表明，与感染风险增加独立相关的因素包括 EVD 放置时间≥8 天（HR=2.47（1.12-5.45）；p=0.03）、定期采样（每天采样（HR=4.73（1.28-17.42），p=0.02）和隔日采样（HR=5.28（2.25-12.38）；p<0.01）。导管类型或隧道距离与 ERI 无关联。
在英国和爱尔兰，研究期间的 ERI 发生率为 9.3%。研究表明，EVD 留置时间≥8 天且采样频率较高与感染风险增加相关。重要的是，该研究表明不同导管类型的 ERI 风险无显著差异。
