Sam Jo Ee, Lim Chee Loon, Sharda Priya, Wahab Nasser Abdul
Department of Neurosurgery, Penang General Hospital, Penang, Malaysia.
Department of Infectious Diseases, Penang General Hospital, Penang, Malaysia.
Asian J Neurosurg. 2018 Apr-Jun;13(2):250-257. doi: 10.4103/ajns.AJNS_150_16.
Ventriculostomy-related infection (VRI) from external ventricular drain (EVD) insertion is a common complication and carries a high mortality rate. Choice of empiric antibiotics depends on the institutions common causative organisms and their susceptibility. We determined risk factors for mortality in patients with VRI, the common organisms causing VRI, and the rate of EVD-related VRI at our institution.
Medical records and operative data of patients with cerebrospinal fluid positive cultures with an EVD inserted from 2012 to 2015 were traced. Forty-five patients with EVD-related VRI were included in the study.
The overall rate of VRI was 6.3%, and the overall mortality rate due to VRI was 48.9%. was the most common organism causing VRI (14 patients, 29.2%) with a mortality rate of 64.3%. Only 14.3% of are sensitive to meropenem and imipenem. We found that patients that had a decompressive craniectomy (DC) had a lower mortality rate ( = 0.042) and patients with a longer duration of the EVD being in place before the diagnosis of VRI had poor outcome ( = 0.040). Multivariate logistic regression was performed and we found that the use of steroid ( = 0.014), infection ( = 0.010), multiple organism infection ( = 0.017), lower Glasgow Coma Scale ( = 0.043), and a longer duration the EVD was in place before the diagnosis of VRI ( = 0.008) were related with higher mortality.
VRI mortality rate is high with an alarming resistance pattern seen in VRI. EVDs should be removed as soon as feasible, and DC may be offered to patients with severe ventriculitis or meningitis.
经皮脑室引流（EVD）置入引起的脑室造口相关感染（VRI）是一种常见并发症，死亡率很高。经验性抗生素的选择取决于机构常见的病原体及其敏感性。我们确定了VRI患者的死亡风险因素、导致VRI的常见病原体以及我们机构EVD相关VRI的发生率。
追溯2012年至2015年期间插入EVD且脑脊液培养阳性患者的病历和手术数据。45例EVD相关VRI患者纳入研究。
VRI的总体发生率为6.3%，VRI导致的总体死亡率为48.9%。是导致VRI最常见的病原体（14例患者，29.2%），死亡率为64.3%。仅14.3%的对美罗培南和亚胺培南敏感。我们发现接受去骨瓣减压术（DC）的患者死亡率较低（=0.042），在诊断VRI之前EVD留置时间较长的患者预后较差（=0.040）。进行多因素逻辑回归分析，我们发现使用类固醇（=0.014）、感染（=0.010）、多重病原体感染（=0.017）、格拉斯哥昏迷量表评分较低（=0.043）以及在诊断VRI之前EVD留置时间较长（=0.008）与较高的死亡率相关。
VRI死亡率很高，在VRI中观察到令人担忧的耐药模式。应尽快拔除EVD，对于严重脑室炎或脑膜炎患者可考虑行DC。
