University of Bezmialem, Faculty of Health Sciences, Department of Nursing, Division of Surgical Nursing, Istanbul, Turkey.
Turk Neurosurg. 2022;32(1):103-111. doi: 10.5137/1019-5149.JTN.34091-21.2.
To compare external ventricular drain-related infection (EVD-RI) rates of two Academic Medical Centers in Turkey and the US in order to determine the key factors.
We performed an observational retrospective cohort study to compare the EVD-RI rates between two hospitals (Hospital T in Turkey; Hospital A in US). We analyzed data gathered from 736 patients (Hospital T, n=237; Hospital A, n=499), in a total of 736 EVD cases which occurred between January 1, 2013 and December 31, 2018. Electronic records of hospitals were searched according to the procedure code ?external ventricular drain?. The study protocol was approved by the audit and clinical governance committees of both participating hospitals.
EVD-RI rates were 18.3 per 1000 days for a total of 3227 catheter days in Hospital T, whereas 4.0 per 1000 cases for a total of 7010 catheter days in Hospital A. The prolonged use of EVD catheter, length of stay, and frequency of number of cerebrospinal fluid sampling were associated with EVD-RI in both hospitals. Cerebrospinal fluid culture of Hospital A was dominant for gram positive 32.6% and gram negative 46.1% rods, whereas for Hospital T, gram positive 39.0% and gram negative 33.9% rods were the main microorganisms for the EVD-RI. There was a correlation, between the duration of antibiotic use and EVD-RI in Hospital T. The nursing care facilities of the hospitals were significantly different. All-cause mortality found to be 12.0% versus 3.7% in Hospital A and Hospital T respectively (p < 0.05).
In both institutions, the EVD-RI was associated with EVD characteristics rather than patients? personal characteristics. Early drain removal and patient discharge should be goals whenever medically appropriate. The wide range infection and mortality rates between Hospital A and T is most likely attributable to many factors, including the variety of populations evaluated and the use of dissimilar methodologies in the management of EDVs.
比较土耳其和美国两家学术医疗中心的外部脑室引流相关感染（EVD-RI）率，以确定关键因素。
我们进行了一项观察性回顾性队列研究，比较了两家医院（土耳其的医院 T 和美国的医院 A）的 EVD-RI 率。我们分析了 2013 年 1 月 1 日至 2018 年 12 月 31 日期间，736 名患者（医院 T，n=237；医院 A，n=499）共 736 例 EVD 病例的数据。根据程序代码“外部脑室引流”搜索医院的电子记录。该研究方案得到了参与的两家医院的审计和临床治理委员会的批准。
在医院 T，EVD 导管总留置时间为 3227 天，EVD-RI 率为每 1000 天 18.3 例；而在医院 A，EVD 导管总留置时间为 7010 天，EVD-RI 率为每 1000 例 4.0 例。EVD 导管的长期使用、住院时间和脑脊液采样次数与两家医院的 EVD-RI 相关。医院 A 的脑脊液培养以革兰阳性 32.6%和革兰阴性 46.1%杆菌为主，而医院 T 的 EVD-RI 主要微生物为革兰阳性 39.0%和革兰阴性 33.9%杆菌。医院 T 中抗生素使用时间与 EVD-RI 之间存在相关性。医院之间的护理设施差异显著。医院 A 和医院 T 的总死亡率分别为 12.0%和 3.7%（p<0.05）。
在这两个机构中，EVD-RI 与 EVD 特征相关，而与患者的个人特征无关。只要在医学上合适，就应尽早拔除引流管并让患者出院。医院 A 和 T 之间的感染率和死亡率差异很大，这可能归因于许多因素，包括评估的人群种类以及 EDV 管理中使用的不同方法。
