Zhou Jialei, Zhong Yi, Li Xiang, Li Hang, Wang Jiahe, Yang Siyuan, Chen Gang
Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University Suzhou, Jiangsu Province, China.
Neurol Clin Pract. 2023 Aug;13(4):e200156. doi: 10.1212/CPJ.0000000000200156.
External ventricular drainage (EVD) is one of the most commonly performed neurosurgical procedures, but EVD-related infection constitutes a significant health concern. Yet, little consensus identifies the risk factors for the development of EVD-related infection. Therefore, we performed a meta-analysis to systematically summarize existing evidence on the incidence and risk factors for EVD-related infection.
PubMed, Embase, and the Cochrane Library databases from database inception to February 28, 2022, were searched for all studies investigating the incidence and risk factors for EVD-related infection. Data were assessed by R-4.2.0 software. The meta-analysis was used to calculate pooled odds ratios (OR) and 95% confidence intervals (CI).
A total of 48 studies were included. Among the 29 factors analyzed, statistically significant risk factors were subarachnoid hemorrhage(SAH)/intraventricular hemorrhage(IVH) (OR = 1.48, 95% CI = 1.20-1.82, < 0.001), concomitant systemic infection (OR = 1.90, 95% CI = 1.34-2.70, < 0.001), other neurosurgical procedures (OR = 1.76, 95% CI = 1.02-3.04, = 0.041), change of catheter (OR = 5.05, 95% CI = 3.67-6.96, < 0.001), bilateral EVDs (OR = 2.25, 95% CI = 1.03-4.89, = 0.041), (cerebrospinal fluid) CSF leak (OR = 3.19, 95% CI = 2.12-4.81, < 0.001) and duration of EVD >7 days (OR = 4.62, 95% CI = 2.26-9.43, < 0.001). The use of silver-coated catheters (OR = 0.57, 95% CI = 0.38-0.87, = 0.008) and antibiotic-impregnated catheters (OR = 0.60, 95% CI = 0.41-0.88, = 0.009) might help reduce the risk of infection. No significant difference was indicated in studies evaluating factors like diabetes mellitus (OR = 1.25, 95% CI = 0.90-1.75, = 0.178), steroids used (OR = 1.52, 95% CI = 0.96-2.4, = 0.074), prophylactic antibiotics(OR = 0.87, 95% CI = 0.66-1.14, = 0.308).
The meta-analysis of various relevant factors in the onset of EVD-related infection in patients submitted to EVD enabled us to establish a more probable profile of the patients who are more likely to develop it during the treatment.
脑室外引流（EVD）是最常实施的神经外科手术之一，但EVD相关感染是一个重大的健康问题。然而，对于EVD相关感染发生的危险因素，目前几乎没有达成共识。因此，我们进行了一项荟萃分析，以系统总结关于EVD相关感染的发生率和危险因素的现有证据。
检索了PubMed、Embase和Cochrane图书馆数据库，从数据库建立至2022年2月28日，查找所有调查EVD相关感染的发生率和危险因素的研究。数据由R-4.2.0软件进行评估。荟萃分析用于计算合并比值比（OR）和95%置信区间（CI）。
共纳入48项研究。在分析的29个因素中，具有统计学意义的危险因素包括蛛网膜下腔出血（SAH）/脑室内出血（IVH）（OR = 1.48，95% CI = 1.20 - 1.82，P < 0.001）、合并全身性感染（OR = 1.90，95% CI = 1.34 - 2.70，P < 0.001）、其他神经外科手术（OR = 1.76，95% CI = 1.02 - 3.
