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22.01.2019 | Original Article - Infection | Ausgabe 3/2019

Acta Neurochirurgica 3/2019

Risk factors for meningitis in neurosurgical patients with cerebrospinal fluid drains: prospective observational cohort study

Zeitschrift:
Acta Neurochirurgica > Ausgabe 3/2019
Autoren:
Khetam Hussein, Galit Rabino, Omri Feder, Haneen Eghbaryeh, Hiba Zayyad, Gil Sviri, Rima Benenson, Mical Paul
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00701-019-03801-y) contains supplementary material, which is available to authorized users.
This article is part of the Topical Collection on Infection

Comments

This is a well performed prospective study of the infectious complications of CNS externalized catheters and monitoring devices. The authors identified already known risk factors such as diabetes, duration of catheter presence, and device sampling rates as the prime culprits in increasing infection rates. The favourable effect of simple infection control interventions is an important observation and mirrors the effectiveness of similar protocols in other invasive monitoring procedures as reported in the literature. The health and economic burden of increasingly multi-drug resistant infections due to CNS drains makes the implementation of infection control protocols a no brainer for health care institutions.
Zvi Harry Rappaport
Petah Tiqvah, Israel

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Abstract

Background

Cerebrospinal fluid (CSF) drainage or intracranial pressure (ICP) monitoring devices are life-saving devices. We examined the risk factors for infections related to them and assessed the effect of an infection control (IC) intervention.

Methods

A prospective observational study was conducted in the Neurosurgical Department of our hospital between 2014 and 2017. We included all consecutive patients undergoing CSF catheter insertions, including external ventricular drainage (EVD), lumbar drainage (LD), and ICP catheters. An IC intervention was implemented between March and August 2016. We examined risk factors for meningitis or ventriculitis, defined according to Healthcare-associated infections surveillance definitions, on univariate and multivariate analysis.

Results

A total of 232 patients with 437 drains (212 EVDs, 92 LDs, and 133 ICPs) were included. On univariate and multivariate analysis, the infection incidence was 13.7 per 1000 drain days (17.3/1000 before IC intervention, 7.9/1000 during, and 9.2/1000 after the intervention). Most episodes were caused by Gram-negative bacteria, and the most common pathogen was Acinetobacter baumanii. Risk factors for infection per patient included diabetes mellitus (p = 0.017), CSF leak (p = 0.032), drain opening (p = 0.027), and the duration of the drain in days (p = 0.035). Risk factors per catheter included drain opening (p < 0.001), drain days (p = 0.001), and the IC intervention period compared to before the intervention period (p = 0.037). When restricting the analysis to EVDs, drain days (p = 0.001) was the only significant risk factor.

Conclusions

Strict adherence to IC, shortening drain duration, and avoiding unnecessary opening and manipulation of the drains are crucial to preventing neurosurgical drain infections.

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