脑室引流管相关感染的预测因素：243 例患者的回顾性研究。

Predictors of Ventriculostomy-Associated Infections: A Retrospective Study of 243 Patients.

机构信息

Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.

Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.

出版信息

World Neurosurg. 2022 Apr;160:e40-e48. doi: 10.1016/j.wneu.2021.12.085. Epub 2021 Dec 29.

DOI:10.1016/j.wneu.2021.12.085

PMID:34971831

Abstract

OBJECTIVE

Risk factors of ventriculostomy-associated infection (VAI) reported in the literature are variable owing to heterogeneity of external ventricular drainage (EVD) procedures and management. This study aimed to assess the rate of VAI and its risk factors.

METHODS

The medical records of patients >18 years old who received EVD catheterizations between January 2015 and December 2020 were retrospectively reviewed.

RESULTS

Among 243 patients with 355 catheters, 23 VAIs were identified, yielding VIA rates of 9.5% per patient and 6.5% per catheter. VAI was associated with a longer total EVD duration (29.2 days vs. 15.8 days, P < 0.001), a longer procedural time (72 minutes vs. 41 minutes, P < 0.001), intraoperative ventriculostomy (39.1% vs. 9.1%, P < 0.001), craniotomy (87.0% vs. 60.9%, P = 0.014), and other systemic infections (30.4% vs. 8.2%, P = 0.004). On multivariate analysis, a longer total EVD duration (odds ratio 1.086, P < 0.001), intraoperative ventriculostomy (odds ratio 6.119, P = 0.001), and other systemic infections (odds ratio 4.620, P = 0.015) were associated with VAI. There was no statistical difference between the VAI rates of patients with and without prophylactic EVD exchanges at a mean 12.6 days (7.1% vs. 2.2%, P = 0.401).

CONCLUSIONS

Intraoperative ventriculostomy was independently associated with VAI. Prophylactic EVD exchange at 12.6 days did not lower VAI rate.

摘要

目的

由于外部脑室引流 (EVD) 程序和管理的异质性，文献中报道的脑室造口相关感染 (VAI) 的危险因素各不相同。本研究旨在评估 VAI 的发生率及其危险因素。

方法

回顾性分析 2015 年 1 月至 2020 年 12 月期间接受 EVD 置管的年龄>18 岁患者的病历。

结果

在 243 例 355 例导管患者中，发现 23 例 VAI，患者 VAI 发生率为 9.5%/例，导管 VAI 发生率为 6.5%/例。VAI 与总 EVD 时间较长（29.2 天比 15.8 天，P<0.001）、手术时间较长（72 分钟比 41 分钟，P<0.001）、术中脑室造口术（39.1%比 9.1%，P<0.001）、开颅术（87.0%比 60.9%，P=0.014）和其他全身感染（30.4%比 8.2%，P=0.004）有关。多变量分析显示，总 EVD 时间较长（比值比 1.086，P<0.001）、术中脑室造口术（比值比 6.119，P=0.001）和其他全身感染（比值比 4.620，P=0.015）与 VAI 相关。在平均 12.6 天（7.1%比 2.2%，P=0.401）进行预防性 EVD 交换的患者中，VAI 发生率无统计学差异。