External ventricular drain and associated infections

Abstract

Purpose. To find out the infections rate associated with external ventricular drainage (EVD); to find out infectious agents and the risk factors and to compare gained data between two neurosurgical clinics in Riga. Materials and methods. This study is retrospective. The study analyzed the flies of 228 patients who underwent EVD from 2007 to 2014 in two neurosurgery hospitals. There were 105 (46.1%) male and 123 (53.9%) female patients. The patients average age was 60 years old (IQR = 75–47). One hundred and ten patients have been operated for rupture of aneurism, spontaneous intracerebral hemorrhage — 70, traumatic brain injury — 21, brain tumor — 12, rupture of arteriovenous malformation — 12, aqueductal stenosis — 2, cerebral infarction — 1. The data were analyzed using Microsoft Exel and SPSS Statistics. Results. Infections associated with EVD occurred in 42 (18.4%) cases: there were 30 (71.4%) bacterial meningitis, 7 (16.6%) bacterial ventriculitis, 5 (11.9%) bacterial meningitis combined with ventriculitis. In Paul Stradins Clinical University Hospital complications rate was 19.05% and in Neurosurgical Hospital Gailezers — 17.28%. Microbiological test revealed Staphylococcus spp. in 16 (38%) cases and Acinetobacter baumannii in 13 (31%) cases. For patients without neuroinfection median duration of drainage was 7 days (IQR = 8–6) and for patients with neuroinfection 10 days (IQR = 14–6,5). The average duration of staying at hospital was 14 days (IQR = 22–9) and 24 days (IQR = 34–19), respectively. Risk factors for EVD related infections were drainage duration (p = 0.000), repeated EVD (p = 0.000) and craniotomy or craniectomy (p = 0.029). EVD related infections treatment was associated with negligible increase of mortality rate (p = 0.106). Conclusion. Bacterial meningitis and ventriculitis are common complications associated with EVD. Neuroinfections were associated with negligibe increase in mortality rate, but significant increase in staying at hospital and might be associated with cognitive decline and enhanced costs. The risk factors for neuroinfections development are drainage duration, repeated EVD, craniotomy or craniectomy. Mortality is associated with initial low level consciousness (GCS ≤ 8 at admission to hospital).