Prospective surveillance of drain associated meningitis/ventriculitis in a neurosurgery and neurological intensive care unit
- 1Department of Infection Control and Infectious Diseases, University Hospital, RWTH Aachen, Germany
- 2Department of Neurosurgery, University Hospital, RWTH Aachen, Germany
- 3Institute of Medical Microbiology, University Hospital, RWTH Aachen, Germany
- 4Department of Neurology, University Hospital, RWTH Aachen, Germany
- 5Division of Infectious Diseases, Department of Internal Medicine, University Cologne, Germany
- Correspondence to Dr S Scheithauer, Department of Infection Control and Infectious Diseases, UK Aachen, RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany;
- Received 14 October 2008
- Revised 8 February 2009
- Accepted 26 February 2009
- Published Online First 16 March 2009
Objectives: There are currently no data available on drain associated infection occurrence related to the number of drainage days (DD), and thus drain associated infection rates. Therefore, a prospective surveillance study was conducted to determine drain associated infection rates and DD of hospital acquired external ventricular drain (EVD) and lumbar drain (LD) associated meningitis/ventriculitis in a neurosurgery and a neurological intensive care unit.
Methods: All patients admitted in 2005 and 2006 were documented. Data on age, admitting diagnosis, type and duration of drain, duration of hospital stay and occurrence of meningitis were recorded and analysed statistically.
Results: A total of 1333 patients were included, amounting to 3023 DD. After exclusion of 15 contaminations, a total of 26 cases of meningitis were reported accounting for an overall device associated meningitis rate of 8.6 infections/1000 DD. Infections associated with LD seemed to occur more frequently (19.9/1000 DD) compared with EVD (6.3/1000 DD). The presence of intraventricular blood and previous trauma were significant risk factors for infection (p = 0.003; p = 0.04). Finally, length of stay was significantly longer in meningitis patients (p = 0.0003). Coagulase negative staphylococci were the main pathogen (56%) causing meningitis, followed by Staphylococcus aureus (25%).
Conclusions: To the best of the authors' knowledge, this study represents the first to provide data on EVD as well as LD associated meningitis rates calculated per 1000 DD; a parameter that is well established for other invasive devices such as central venous and urinary tract catheters. However, further prospective studies are needed to investigate the possible risk factors for meningitis.
See Editorial Commentary, p 1302
Results were presented in part as an oral presentation at the 60th Annual Meeting of the DGHM, Dresden, Germany, 21–24 September 2008.
Competing interests None.
Ethics approval Ethics approval was decided by request; no formal proposal was required as no intervention was planned, only a description of anonymised data. Professor Dr Schmalzing, Director of the Ethics Committee, University of Aachen.
Provenance and Peer review Not commissioned; externally peer reviewed.