Prospective, multicentre study of external ventricular drainage-related infections in the UK and Ireland.
Authors
Jamjoom, Aimun AB
Chari, Aswin
Zaben, Malik
Abdulla, Mutwakil AH
Roach, Joy
Glancz, Laurence J
Solth, Anna
Duddy, John
Brennan, Paul M
Mallucci, Conor L
Jenkinson, Michael D
Kandasamy, Jothy
British Neurosurgical Trainee Research Collaborative,
Publication Date
2018-02Journal Title
Journal of neurology, neurosurgery, and psychiatry
ISSN
0022-3050
Publisher
BMJ
Volume
89
Issue
2
Pages
120-126
Language
eng
Type
Article
This Version
VoR
Physical Medium
Print-Electronic
Metadata
Show full item recordCitation
Jamjoom, A. A., Joannides, A., Poon, M. T., Chari, A., Zaben, M., Abdulla, M. A., Roach, J., et al. (2018). Prospective, multicentre study of external ventricular drainage-related infections in the UK and Ireland.. Journal of neurology, neurosurgery, and psychiatry, 89 (2), 120-126. https://doi.org/10.1136/jnnp-2017-316415
Abstract
Objectives
External Ventricular Drain (EVD) insertion is a common neurosurgical procedure. EVDrelated
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 United Kingdom (UK) and Ireland and
determine key factors influencing the infection risk.
Methods
A prospective multi-centre 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 Hazard Ratios (HR).
Results
A total of 495 EVD catheters were inserted into 452 patients with EVDs remaining in-situ for
4700 days (median 8 days; interquartile range 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.
Keywords
British Neurosurgical Trainee Research Collaborative, Cerebral Ventricles, Humans, Staphylococcal Infections, Postoperative Complications, Ventriculostomy, Neurosurgical Procedures, Proportional Hazards Models, Prospective Studies, Catheters, Indwelling, Adolescent, Adult, Aged, Aged, 80 and over, Middle Aged, Child, Child, Preschool, Infant, Infant, Newborn, Ireland, Female, Male, Catheter-Related Infections, Young Adult, United Kingdom
Embargo Lift Date
2100-01-01
Identifiers
External DOI: https://doi.org/10.1136/jnnp-2017-316415
This record's URL: https://www.repository.cam.ac.uk/handle/1810/270951
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