Effectiveness of a Chlorhexidine Dressing on Silver-coated External Ventricular Drain–associated Colonization and Infection: A Prospective Single-blinded Randomized Controlled Clinical Trial

Roethlisberger, Michel; Moffa, Giusi; Fisch, Urs; Wiggli, Benedikt; Schoen, Stephan; Kelly, Christopher; Leu, Severina; Croci, Davide Marco; Zumofen, Daniel; Cueni, Nadine; Nogarth, Danica; Schulz, Marianne; Bucher, Heiner C.; Weisser, Maja; Wasner, M.; Widmer, Andreas F.; Mariani, Luigi

doi:10.1093/cid/ciy393

Cited by 19 publications

(16 citation statements)

References 34 publications

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“…The mechanisms behind the transition of hydrocephalus from an acute to a chronic condition have yet to be fully understood. Inflammation induced by EVDAI can lead to CSF circulation disturbances through ependymal cell dysfunction, CSF barrier cell inflammation with increased CSF secretion, and infectious debris blocking CSF outflow [8][9][10]. Interestingly, the present study demonstrated a higher ratio of catheter colonization to EVDAI in the early group than in the late group (7/1 out of 20 patients vs. 7/7 out of 19 patients; Table 2).…”

Section: Discussionmentioning

confidence: 54%

“…From a pathophysiological perspective, longer EVD duration promotes progressive catheter colonization from growing skin flora contaminants over time that might induce inflammatory processes. Pathogens at the skin site and CSF leakage were found to be independent predictors of EVDAI [9,38]. As previously discussed, a predisposition for bacterial infection induced by immunodepression might accentuate this risk specifically in the subset of aSAH patients [4][5][6]37].…”

Section: Discussionmentioning

confidence: 67%

“…Nowadays, EVDAI is considered to be one of the most important nosocomial infections that negatively influence the neurological outcome of aSAH patients. Acknowledged mechanisms behind this clinical observation are the exacerbation of inflammatory processes, thrombogenicity, and disturbances of CSF-dynamics [8][9][10][11][12][13][14]. According to the literature, between 8% and 63% of aSAH patients eventually undergo a permanent CSF diversion (shunting) procedure [3,15].…”

Section: Introductionmentioning

confidence: 99%

“…Cases of EVDAI were confirmed in accordance with the modified criteria for nosocomial infections of the Centers for Disease Control and Prevention (CDC) [34]. A positive culture of CSF or a ventricular catheter tip without other abnormal CSF findings or clinical signs suggesting infection was designated as colonization [9,34]. EVDAI was diagnosed if a positive culture of the CSF or catheter tip was present and accompanied by further pathological CSF findings or at least one new sign or symptom of CNS infection in the absence of any other known cause [9,34].…”

mentioning

confidence: 99%

“…A positive culture of CSF or a ventricular catheter tip without other abnormal CSF findings or clinical signs suggesting infection was designated as colonization [9,34]. EVDAI was diagnosed if a positive culture of the CSF or catheter tip was present and accompanied by further pathological CSF findings or at least one new sign or symptom of CNS infection in the absence of any other known cause [9,34]. EVDAI was also diagnosed in some cases with negative cultures in which there were pathological CSF findings and/or clinical manifestations of infection and antimicrobial therapy was given [9,34].…”

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confidence: 99%

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Early permanent cerebrospinal fluid diversion lowers the rate of nosocomial meningitis in aneurysmal subarachnoid hemorrhage

Croci

Dalolio

Aghlmandi

et al. 2020

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Background: Early permanent cerebrospinal fluid (CSF) diversion for hydrocephalus after aneurysmal subarachnoid hemorrhage (aSAH) might shorten the duration of external ventricular drainage (EVD) and thereby reduce infectious complications. The potential effect on the rate of delayed cerebral vasospasm (DCVS) and associated morbidity has not been studied to date. The objective of this study was to detect any association with EVD-associated infections (EVDAI), symptomatic DCVS, or delayed cerebral ischemia (DCI) by the time of hospital discharge. Methods: A single-center dataset of aSAH patients who received a permanent CSF diversion procedure between 2009 and 2018 was used for the evaluation. The subjects were divided into an “early group” if such a procedure was performed up to 14 days after the ictus, and a “late group” if it was performed from the 15 th day onward. The statistical analysis employed univariable and multivariable logistic regression models. Results: Among 274 consecutive aSAH patients, 39 (14.2 %) had a permanent CSF diversion procedure. While the blood clot burden was similarly distributed, patients with early permanent CSF diversion (20 out of 39, 51.2%) had higher levels of consciousness on admission. Early permanent CSF diversion was associated with a shorter duration of EVD (OR 0.73, 95%CI 0.58-0.92 per day). Higher catheter colonization to EVDAI ratio (1/7 out of 20 vs. 7/7 out of 19) and a markedly lower frequency of EVDAI (OR 0.08, 95 %CI 0.01-0.80) were detected. The prevalence (5 vs. 37) and the cumulative incidence (3 vs. 18) of EVDAI were remarkably lower in patients receiving early permanent CSF diversion. The occurrence of CSF-diversion device obstruction, the rate of symptomatic DCVS (OR 0.61, 95 %CI 0.16-2.27) or detected DCI on computed tomography (OR 0.35, 95 %CI 0.08-1.47), and the likelihood of a poor outcome at discharge did not differ between the two groups (OR 0.88, 95%CI 0.24-3.22). Conclusions: Early permanent CSF diversion in good grade aSAH patients is associated with a shorter duration of EVD, lower catheter colonization rates, and fewer infectious complications. The timing of permanent CSF diversion had no detectable effect on DCVS-related morbidity. These findings need to be confirmed in larger cohorts.

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 67%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Early permanent cerebrospinal fluid diversion lowers the rate of nosocomial meningitis in aneurysmal subarachnoid hemorrhage

Croci

Dalolio

Aghlmandi

et al. 2020

Preprint

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Management of external ventricular drain: to wean or not to wean?

Hallenberger,

Tharmagulasingam,

Licci

et al. 2024

Acta Neurochir

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Purpose External ventricular drain (EVD) is one of the most frequent procedures in neurosurgery and around 15 to 30% of these patients require a permanent cerebrospinal fluid (CSF) diversion. The optimal EVD weaning strategy is still unclear. Whether gradual weaning compared to rapid closure, reduces the rate of permanent CSF diversion remains controversial. The aim of this trial is to compare the rates of permanent CSF diversion between gradual weaning and rapid closure of an EVD. Methods This was a single-center, retrospective cohort study including patients between 2010 to 2020. Patients were divided into a weaning (WG) and non-weaning (NWG) group. The primary outcome was permanent CSF diversion rates, secondary outcomes included hospitalization time, EVD-related morbidity, and clinical outcome. Results Out of 412 patients, 123 (29.9%) patients were excluded due to early death or palliative treatment. We registered 178 (61.6%) patients in the WG and 111 (38.4%) in the NWG. Baseline characteristics were comparable between groups. The VPS rate was comparable in both groups (NWG 37.8%; WG 39.9%, p = 0.728). EVD related infection (13.5% vs 1.8%, p < 0.001), as well as non-EVD related infection rates (2.8% vs 0%, p < 0.001), were significantly higher in the WG. Hospitalization time was significantly shorter in the NWG (WG 24.93 ± 9.50 days; NWG 23.66 ± 14.51 days, p = 0.039). Conclusion Gradual EVD weaning does not seem to reduce the need for permanent CSF diversion, while infection rates and hospitalization time were significantly higher/longer. Therefore, direct closure should be considered in the clinical setting.

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Effectiveness of a multimodal strategy to reduce external ventricular drain–associated infection: A quasi-experimental study

Pongkaew,

Noiphithak,

Rukskul

et al. 2024

American Journal of Infection Control

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Effectiveness of a Chlorhexidine Dressing on Silver-coated External Ventricular Drain–associated Colonization and Infection: A Prospective Single-blinded Randomized Controlled Clinical Trial

Abstract: NCT02078830.

Cited by 19 publications

References 34 publications

Early permanent cerebrospinal fluid diversion lowers the rate of nosocomial meningitis in aneurysmal subarachnoid hemorrhage

Early permanent cerebrospinal fluid diversion lowers the rate of nosocomial meningitis in aneurysmal subarachnoid hemorrhage

Management of external ventricular drain: to wean or not to wean?

Effectiveness of a multimodal strategy to reduce external ventricular drain–associated infection: A quasi-experimental study

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