de Andrade A Y T, Canicoba A R B, Oliveira R A, Gnatta J R, de Brito Poveda V
Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, São Paulo, Brazil.
Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, São Paulo, Brazil.
J Hosp Infect. 2025 Aug;162:368-376. doi: 10.1016/j.jhin.2024.07.004. Epub 2024 Jul 19.
Infection associated with the use of the external ventricular drainage (EVD) catheter in neurosurgery is linked to high morbidity and mortality, and various mechanisms are related to its occurrence. This systematic review with meta-analysis aimed to summarize and update the risk factors associated with EVD-related infection, utilizing grey literature and indexed databases. Thirty studies were included, of which nine contributed to the meta-analysis. The reported frequency of EVD-related infection varied from 1.9% to 36%, and the diagnostic criteria for infection were not standardized, with the presence of a positive culture being the most common. The primary micro-organisms identified were Staphylococcus spp. and Pseudomonas spp. Key risk factors included duration of catheterization, frequency of maintenance care, reinsertion, or number of drains. The results of the meta-analysis showed a significant effect in patients with prolonged use of EVDs, with an increase in risk of 1.47 (odds ratio) (95% confidence interval (CI) 1.03, 2.10) for each day of use (P=0.03), and showed that the number of cerebrospinal fluid collections was higher in the group with infection (P=0.00), while a greater number of EVDs used was related to a significant effect on infection rates (P=0.00), which were revealed from studies with low heterogeneity (I: 0%). The results indicated studies with high heterogeneity and low quality of evidence, with risk factors associated with the maintenance or management of EVD.
神经外科使用外部脑室引流（EVD）导管相关的感染与高发病率和死亡率相关，其发生涉及多种机制。这项带有荟萃分析的系统评价旨在利用灰色文献和索引数据库，总结和更新与EVD相关感染的危险因素。纳入了30项研究，其中9项纳入了荟萃分析。报道的EVD相关感染发生率从1.9%到36%不等，感染的诊断标准未标准化，培养阳性最为常见。鉴定出的主要微生物为葡萄球菌属和假单胞菌属。关键危险因素包括置管持续时间、维护护理频率、重新置管或引流管数量。荟萃分析结果显示，EVD使用时间延长的患者有显著影响，使用每一天感染风险增加1.47（比值比）（95%置信区间（CI）1.03，2.10）（P = 0.03），且感染组脑脊液采集次数更多（P = 0.00），而使用更多数量的EVD对感染率有显著影响（P = 0.00），这是从异质性低（I：0%）的研究中得出的。结果表明研究存在高异质性和低证据质量，以及与EVD维护或管理相关的危险因素。
