Department of Microbiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, Kerala, India.
Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, Kerala, India.
Indian J Med Microbiol. 2024 Mar-Apr;48:100534. doi: 10.1016/j.ijmmb.2024.100534. Epub 2024 Feb 21.
Device-associated CNS infections is a major subgroup of healthcare associated CNS infections. Healthcare-associated ventriculitis or meningitis differs considerably from community-acquired meningitis in its epidemiology, pathogenesis, clinical presentation and management.
This study aimed to identify the infection rates, the associated risk factors, and outcomes of these life-threatening infections.
This was a 2-year single center prospective cohort study. Patient's clinical data, laboratory parameters, treatment and their outcomes were collected using data collection tool, and device days were collected from the hospital information system (HIS). Patients were categorised using IDSA criteria as contamination or colonisation or infection. Cox regression model was used for multivariate analysis to estimate hazard risk.
A total of 578 CSF diversion catheters were inserted in 472 patients. The average rate for EVD and LD infection were 11.12 and 11.86 per 1000 device days respectively. The average infection rates for VP and LP shunts were 6% and 5.2% per procedure, respectively. The commonest etiological agent causing CSF diversion catheter-related infection (CDRI) was Klebsiella pneumoniae (n = 14, 40%). The risk factors which were independently associated with increased infection risk by cox regression analysis were drain insertion ≥7 days [HR:11.73, p -0.03], posterior approach of EVD insertion (occipital) [HR:9.53, p - 0.01], pre-OP ASA score>3 [HR:8.28, p - 0.013] presence of EVD/LD leak [HR: 17.24, p < 0.0001], male gender [HR:2.05, p-0.05] and presence of associated peri-operative scalp infections [HR:3.531, p-0.005]. Shift to narrow spectrum surgical prophylactic antibiotic [Coefficient: -1.284, p-0.03] and reduction in CSF sampling frequency [Coefficient: -1.741, p-0.02] were found to be negatively associated with CDRI.
The study demonstrated drain insertion ≥7 days, posterior approach of EVD insertion, presence of EVD/LD leak, male gender and presence of associated peri-operative scalp skin and soft tissue infections were associated with increased risk of infection.
与器械相关的中枢神经系统感染是与医疗保健相关的中枢神经系统感染的主要亚组。医疗保健相关的脑室炎或脑膜炎在其流行病学、发病机制、临床表现和管理方面与社区获得性脑膜炎有很大不同。
本研究旨在确定这些危及生命的感染的感染率、相关危险因素和结局。
这是一项为期 2 年的单中心前瞻性队列研究。使用数据收集工具收集患者的临床数据、实验室参数、治疗及其结果，并从医院信息系统（HIS）中收集器械使用天数。根据 IDSA 标准，患者被归类为污染或定植或感染。使用 Cox 回归模型进行多变量分析以估计危险风险。
共插入 472 例患者的 578 个 CSF 引流导管。EVD 和 LD 感染的平均发生率分别为每 1000 个器械日 11.12 和 11.86 个。VP 和 LP 分流器的平均感染率分别为每例 6%和 5.2%。导致 CSF 分流导管相关感染（CDRI）的最常见病原体是肺炎克雷伯菌（n=14，40%）。Cox 回归分析表明，与感染风险增加相关的独立危险因素是引流管插入时间≥7 天[HR：11.73，p-0.03]、EVD 插入的后入路（枕部）[HR：9.53，p-0.01]、术前 ASA 评分>3[HR：8.28，p-0.013]、EVD/LD 漏[HR：17.24，p<0.0001]、男性[HR：2.05，p-0.05]和围手术期头皮感染[HR：3.531，p-0.005]。窄谱手术预防性抗生素的使用[系数：-1.284，p-0.03]和 CSF 采样频率的降低[系数：-1.741，p-0.02]与 CDRI 呈负相关。
研究表明，引流管插入时间≥7 天、EVD 插入的后入路、EVD/LD 漏、男性和围手术期头皮皮肤和软组织感染与感染风险增加相关。
