Article Text
Abstract
Objectives External ventricular drain (EVD) insertion is a common neurosurgical procedure. EVD-related infection (ERI) is a major complication that can lead to morbidity and mortality. In this study, we aimed to establish a national ERI rate in the UK and Ireland and determine key factors influencing the infection risk.
Methods A prospective multicentre cohort study of EVD insertions in 21 neurosurgical units was performed over 6 months. The primary outcome measure was 30-day ERI. A Cox regression model was used for multivariate analysis to calculate HR.
Results A total of 495 EVD catheters were inserted into 452 patients with EVDs remaining in situ for 4700 days (median 8 days; IQR 4–13). Of the catheters inserted, 188 (38%) were antibiotic-impregnated, 161 (32.5%) were plain and 146 (29.5%) were silver-bearing. A total of 46 ERIs occurred giving an infection risk of 9.3%. Cox regression analysis demonstrated that factors independently associated with increased infection risk included duration of EVD placement for ≥8 days (HR=2.47 (1.12–5.45); p=0.03), regular sampling (daily sampling (HR=4.73 (1.28–17.42), p=0.02) and alternate day sampling (HR=5.28 (2.25–12.38); p<0.01). There was no association between catheter type or tunnelling distance and ERI.
Conclusions In the UK and Ireland, the ERI rate was 9.3% during the study period. The study demonstrated that EVDs left in situ for ≥8 days and those sampled more frequently were associated with a higher risk of infection. Importantly, the study showed no significant difference in ERI risk between different catheter types.
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Footnotes
Contributors All authors have made substantial contributions to conception and design, acquisition of data or analysis and interpretation of data; drafting of the article or revising it critically for important intellectual content and provided final approval of the version to be published. Roles were as follows: AABJ, AIA: study idea conception, protocol development, research infrastructure organisation, data collection, data analysis, manuscript writing/drafting. AJJ: study idea conception, protocol development, online database development/management, manuscript writing/drafting. MT-CP: data analysis (principle), manuscript writing/drafting. AC, RB, DOB, CLM, MDJ, WPG, JK: protocol development, research infrastructure organisation, manuscript writing/drafting. MZ, PMB: protocol development, research infrastructure organisation, data collection, manuscript writing/drafting. MAHA: research infrastructure organisation, data collection, manuscript writing. JR, LJG, AS, JD: research infrastructure organisation, data collection, manuscript writing/drafting. PJH: study idea conception, protocol development, manuscript writing/drafting. AGK: study idea conception, protocol development, research infrastructure organisation, data collection, manuscript writing/drafting.
Funding PJH is supported by a NIHR Research Professorship and the Cambridge NIHR BRC. The study in this report was funded by the Society of British Neurological Surgeons. AABJ is undertaking a PhD funded by the Wellcome Trust. AIA is funded by the Academy of Medical Sciences Clinical Lecturer Starter Grant.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.