The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang Province, China.
Surg Infect (Larchmt). 2021 Mar;22(2):211-216. doi: 10.1089/sur.2019.355. Epub 2020 Apr 29.
Ventriculostomy-related infection (VRI) is one of the most severe and common complications of external ventricular drains (EVD). Ward environment is closely related to hospital-acquired infection, but its role in EVD infection is unclear. For some other recognized risk factors, clinical evidence also remains complicated and undetermined. We aimed to evaluate ward environment including multi-bed accommodation and intensive care unit (ICU) stay as potential risk factors for VRI, as well as to confirm those already known factors. We reviewed EVDs retrospectively in our center between January 2012 and January 2017. Univariable and logistic regression analysis were performed to identify risk factors for EVD-related infection. A total of 284 patients who underwent EVD procedure were included. Thirty-six (12.7%) developed EVD-related infection. Univariable analysis revealed that the infection group had longer intensive care unit (ICU) stay (6.81 vs. 3.65 days, p = 0.045) but multi-bed accommodation showed no statistical difference between the two groups (p = 0.404). Univariable analysis also showed VRI patients had lower pre-operational Glasgow Coma Scale (6.89 vs. 9.32, p = 0.001), longer drainage placement duration (11.4 vs. 8.30 days, p < 0.001), greater numbers of cerebrospinal fluid (CSF) sampling (3.89 vs. 1.73, p < 0.001), higher percentage of pre-operational artificial airway status (50.0% vs. 18.1%, p < 0.001), and higher percentage of intracranial hemorrhage diagnosis (88.9% vs. 73.8%, p = 0.048). Logistic regression analysis demonstrated longer post-operational ICU stay (>5 days, odds ratio [OR] = 3.21, p = 0.026) as independent risk factor for EVD-related infection. Other independent risk factors included CSF sampling counts (>3, OR = 5.14, p <0.001), EVD duration (>7 days, OR = 3.85, p = 0.028), and pre-operational artificial airway status (OR = 2.85, p = 0.038). Longer post-operational ICU stay, frequent CSF sampling, longer duration of EVD placement, and pre-operational intubation are independent risk factors for EVD infection. Multi-bed accommodation and bilateral EVD placement have no substantial influence on VRI risk.
脑室引流相关感染（VRI）是外引流（EVD）最严重和最常见的并发症之一。病房环境与医院获得性感染密切相关，但它在 EVD 感染中的作用尚不清楚。对于其他一些公认的危险因素，临床证据仍然复杂且不确定。我们旨在评估病房环境，包括多床住宿和重症监护病房（ICU）入住情况，作为 VRI 的潜在危险因素，并确认那些已经确定的危险因素。我们回顾性地分析了我们中心 2012 年 1 月至 2017 年 1 月期间的 EVD。进行单变量和逻辑回归分析以确定与 EVD 相关感染的危险因素。共有 284 例患者接受了 EVD 手术。36 例（12.7%）发生 EVD 相关感染。单变量分析显示，感染组 ICU 入住时间更长（6.81 天 vs. 3.65 天，p=0.045），但多床住宿在两组之间无统计学差异（p=0.404）。单变量分析还显示，VRI 患者术前格拉斯哥昏迷评分较低（6.89 分 vs. 9.32 分，p=0.001），引流放置时间较长（11.4 天 vs. 8.30 天，p<0.001），脑脊液采样次数较多（3.89 次 vs. 1.73 次，p<0.001），术前人工气道状态比例较高（50.0% vs. 18.1%，p<0.001），颅内出血诊断比例较高（88.9% vs. 73.8%，p=0.048）。Logistic 回归分析表明，术后 ICU 入住时间较长（>5 天，比值比[OR] = 3.21，p=0.026）是 EVD 相关感染的独立危险因素。其他独立危险因素包括脑脊液采样次数（>3 次，OR = 5.14，p<0.001）、EVD 放置时间（>7 天，OR = 3.85，p=0.028）和术前人工气道状态（OR = 2.85，p=0.038）。术后 ICU 入住时间较长、频繁脑脊液采样、EVD 放置时间延长和术前插管是 EVD 感染的独立危险因素。多床住宿和双侧 EVD 放置对 VRI 风险没有实质性影响。
