Prevalence Of And Risk Factors For External Ventricular Drain Related Infections

PurposeThis study aims to estimate the prevalence of EVD related infection and to identify its new risk factors.This study is also supposed to confirm and provide novel clinical evidence for those already known factors.MethodsThis study contains two parts.The first part is a retrospective case-control study which includes 284 adult patients underwent EVD procedure from 2012 to 2017.The second part is a prospective cohort study which includes 55 adult patients underwent EVD procedure from 2017 to 2018.These 55 patients were divided into 2 groups.The first group(long ICU duration)included those patients failed to discharge from ICU at 48h after the procedure and the secend group(short ICU duration)included patients never went to or discharged from ICU within 48h after the procedure.Univariate and logistic regression analysis are performed to identify risk factors of EVD related infection.Cause and effect relationship is discussed in the 2nd part.ResultsIn the 1st part,12.7%patients developed EVD related infection and so did 14.5%patients in 2nd part.The overall infection rate is 12.9%.Logistic regression analysis demonstrates frequent CSF sampling(>3,OR=5.01,95%CI=2.15-11.67,P=0.000),longer duration of EVD placement(>7 days,OR=3.46,95%CI=1.08-11.16,p=0.037)and longer post-operational ICU stay(>5 days,OR=2.40,95%CI=1.03-5.62,p=0.043)as independent risk factors for EVD related infection.Preoperational artificial airway status(p=0.057),preoperational GCS(?8,p=0.843)and preoperational intracranial hemorrhage(p=0.611)are not independent risk factors although they show statistical significance in univariate analysis.The prospective study indicates long ICU stay could be the cause of increasing EVD related infection risk(RR=9.04,95%CI=1.19-68.6,p=0.016).The EVD duration before infection(p=0.911)and CSF sampling times before infection(p=0.138)show no statistical significance in prospective study.A total of 18 patients got positive CSF culture results,6 of which were Staphylococcus infection(including one MRSA infection).Six were Acinetobacter baumanii infection and 2 were Pseudomonas aeruginosa infection.ConclusionThe prevalence of EVD related infection in this medical center is comparable with previous studies.Frequent CSF sampling,longer duration of EVD placement and longer post-operational ICU stay are independent risk factors for EVD related infection.Preoperational artificial airway status,preoperational GCS and preoperational intracranial hemorrhage might be related to higher infection risk but are not independent risk factors.MDR bacteria in EVD related infection should be noted.