Risk Factors Promoting External Ventricular Drain Infections in Adult Neurosurgical Patients at the Intensive Care Unit—A Retrospective Study

Objectives: Multiple risk factors have been described to be related to external ventricular drain (EVD) associated infections, with results varying between studies. Former studies were limited by a non-uniform definition of EVD associated infection, thus complicating a comparison between studies. In...

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Autores principales:	Farjad Khalaveh, Nadia Fazel, Mario Mischkulnig, Matthias Gerhard Vossen, Andrea Reinprecht, Christian Dorfer, Karl Roessler, Johannes Herta
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	external ventricular drain EVD associated infection colonization contamination risk factors promoting EVD infections ventriculitis Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/758b38be6ea2453ca7cda266dc4d0f77
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spelling	oai:doaj.org-article:758b38be6ea2453ca7cda266dc4d0f772021-11-10T14:24:03ZRisk Factors Promoting External Ventricular Drain Infections in Adult Neurosurgical Patients at the Intensive Care Unit—A Retrospective Study1664-229510.3389/fneur.2021.734156https://doaj.org/article/758b38be6ea2453ca7cda266dc4d0f772021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fneur.2021.734156/fullhttps://doaj.org/toc/1664-2295Objectives: Multiple risk factors have been described to be related to external ventricular drain (EVD) associated infections, with results varying between studies. Former studies were limited by a non-uniform definition of EVD associated infection, thus complicating a comparison between studies. In this regard, we assessed risk factors promoting EVD associated infections and propose a modified practice-oriented definition of EVD associated infections.Methods: We performed a retrospective, single-center study on patients who were treated with an EVD, at the neurosurgical intensive care unit (ICU) at a tertiary center between 2008 and 2019. Based on microbiological findings and laboratory results, patients were assigned into an infection and a non-infection group. Patient characteristics and potential risk factors were compared between the two groups (p < 0.05). Receiver operating characteristics (ROC) for significant clinical, serum laboratory and cerebrospinal fluid (CSF) parameters were calculated.Results: In total, 396 patients treated with an EVD were included into the study with a mean age of 54.3 (range: 18–89) years. EVD associated infections were observed in 32 (8.1%) patients. EVD insertion at another hospital (OR 3.86), and an increased CSF sampling frequency of more than every third day (OR 12.91) were detected as major risk factors for an EVD associated infection. The indication for EVD insertion, surgeon's experience, the setting of EVD insertion (ICU vs. operating room) and the operating time did not show any significant differences between the two groups. Furthermore, ROC analysis showed that clinical, serum laboratory and CSF parameters did not provide specific prediction of EVD associated infections (specificity 44.4%). This explains the high overtreatment rate in our cohort with the majority of our patients who received intrathecal vancomycin (63.3%), having either negative microbiological results (n = 12) or were defined as contaminations (n = 7).Conclusions: Since clinical parameters and blood analyzes are not very predictive to detect EVD associated infections in neurosurgical patients, sequential but not too frequent microbiological and laboratory analysis of CSF are still necessary. Furthermore, we propose a uniform classification for EVD associated infections to allow comparability between studies and to sensitize the treating physician in determining the right treatment.Farjad KhalavehNadia FazelMario MischkulnigMatthias Gerhard VossenAndrea ReinprechtChristian DorferKarl RoesslerJohannes HertaFrontiers Media S.A.articleexternal ventricular drainEVD associated infectioncolonizationcontaminationrisk factors promoting EVD infectionsventriculitisNeurology. Diseases of the nervous systemRC346-429ENFrontiers in Neurology, Vol 12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	external ventricular drain EVD associated infection colonization contamination risk factors promoting EVD infections ventriculitis Neurology. Diseases of the nervous system RC346-429
spellingShingle	external ventricular drain EVD associated infection colonization contamination risk factors promoting EVD infections ventriculitis Neurology. Diseases of the nervous system RC346-429 Farjad Khalaveh Nadia Fazel Mario Mischkulnig Matthias Gerhard Vossen Andrea Reinprecht Christian Dorfer Karl Roessler Johannes Herta Risk Factors Promoting External Ventricular Drain Infections in Adult Neurosurgical Patients at the Intensive Care Unit—A Retrospective Study
description	Objectives: Multiple risk factors have been described to be related to external ventricular drain (EVD) associated infections, with results varying between studies. Former studies were limited by a non-uniform definition of EVD associated infection, thus complicating a comparison between studies. In this regard, we assessed risk factors promoting EVD associated infections and propose a modified practice-oriented definition of EVD associated infections.Methods: We performed a retrospective, single-center study on patients who were treated with an EVD, at the neurosurgical intensive care unit (ICU) at a tertiary center between 2008 and 2019. Based on microbiological findings and laboratory results, patients were assigned into an infection and a non-infection group. Patient characteristics and potential risk factors were compared between the two groups (p < 0.05). Receiver operating characteristics (ROC) for significant clinical, serum laboratory and cerebrospinal fluid (CSF) parameters were calculated.Results: In total, 396 patients treated with an EVD were included into the study with a mean age of 54.3 (range: 18–89) years. EVD associated infections were observed in 32 (8.1%) patients. EVD insertion at another hospital (OR 3.86), and an increased CSF sampling frequency of more than every third day (OR 12.91) were detected as major risk factors for an EVD associated infection. The indication for EVD insertion, surgeon's experience, the setting of EVD insertion (ICU vs. operating room) and the operating time did not show any significant differences between the two groups. Furthermore, ROC analysis showed that clinical, serum laboratory and CSF parameters did not provide specific prediction of EVD associated infections (specificity 44.4%). This explains the high overtreatment rate in our cohort with the majority of our patients who received intrathecal vancomycin (63.3%), having either negative microbiological results (n = 12) or were defined as contaminations (n = 7).Conclusions: Since clinical parameters and blood analyzes are not very predictive to detect EVD associated infections in neurosurgical patients, sequential but not too frequent microbiological and laboratory analysis of CSF are still necessary. Furthermore, we propose a uniform classification for EVD associated infections to allow comparability between studies and to sensitize the treating physician in determining the right treatment.
format	article
author	Farjad Khalaveh Nadia Fazel Mario Mischkulnig Matthias Gerhard Vossen Andrea Reinprecht Christian Dorfer Karl Roessler Johannes Herta
author_facet	Farjad Khalaveh Nadia Fazel Mario Mischkulnig Matthias Gerhard Vossen Andrea Reinprecht Christian Dorfer Karl Roessler Johannes Herta
author_sort	Farjad Khalaveh
title	Risk Factors Promoting External Ventricular Drain Infections in Adult Neurosurgical Patients at the Intensive Care Unit—A Retrospective Study
title_short	Risk Factors Promoting External Ventricular Drain Infections in Adult Neurosurgical Patients at the Intensive Care Unit—A Retrospective Study
title_full	Risk Factors Promoting External Ventricular Drain Infections in Adult Neurosurgical Patients at the Intensive Care Unit—A Retrospective Study
title_fullStr	Risk Factors Promoting External Ventricular Drain Infections in Adult Neurosurgical Patients at the Intensive Care Unit—A Retrospective Study
title_full_unstemmed	Risk Factors Promoting External Ventricular Drain Infections in Adult Neurosurgical Patients at the Intensive Care Unit—A Retrospective Study
title_sort	risk factors promoting external ventricular drain infections in adult neurosurgical patients at the intensive care unit—a retrospective study
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/758b38be6ea2453ca7cda266dc4d0f77
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Risk Factors Promoting External Ventricular Drain Infections in Adult Neurosurgical Patients at the Intensive Care Unit—A Retrospective Study

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