Risk factors for infection associated with the use of external ventricular drainage: a systematic review with meta-analysis.

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.