Prospective surveillance of drain associated meningitis/ventriculitis in a neurosurgery and neurological intensive care unit

Abstract

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.Nosocomial infection rates mainly correspond with the severity of illness and exposure to invasive devices.1 External ventricular drains (EVD) and lumbar drains (LD) are commonly used to control hydrocephalus and to monitor and decrease intracranial pressure. Ventriculostomy related infections are a serious problem in up to 40% of patients. [2][3][4][5]

Infections of external ventricular drainages

“…The study by Mayhall et al established a higher incidence of ventriculitis when EVDs were inserted for more than 5 days [11]. One of the studies, performed by Scheithauer et al, denied any correlation between the duration of the drainage and the incidence of infection [19]. The correlation between the duration of EVD replacements and the incidence of an EVD-associated infection was well established in our research.…”

“…In one of the study it was demonstrated that hemorrhagic CSF -as a consequence of SAH or intraventricular hemorrhage (IVH) -occurred four times more frequently with a group of infected patients compared to the non-infected group [15]. Additionally the potential effect of SAH and IVH on the infection rate was mentioned in some of the later studies [7,[16][17][18][19]. Within our study the correlation between SAH and higher incidence of infections proved to be significant.…”

Antibiotic-Impregnated Versus Silver-Bearing External Ventricular Drainage Catheters: Preliminary Results in a Randomized Controlled Trial

“…With six (10 %) confirmed and five (8 %) probable infections, the overall infection rate was comparable with previous published data [3,4,6,8,9,11].…”

“…Perioperative complications, however, such as infections, intracranial hemorrhages (ICHs), or catheter malplacements are well known [3,4]. Several previous trials have focused on catheter related cerebrospinal fluid infections (CSF) and bacterial colonization due to different types of EVDs (0-27 %), [4][5][6][7].…”

External Ventricular Drainage Infections: Experience From a Tertiary Care Center in Nepal

“…13,14 However in our study we have only labeled those patients who had a positive CSF culture along with clinical symptoms i.e. we have only taken into consideration the fi rst criterion in defi ning EVD-related infection.…”