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

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.

Epidemiology and risk factors of neurosurgical bacterial meningitis/encephalitis induced by carbapenem resistant Enterobacteriaceae

“…Meningitis/encephalitis in neurosurgery has posed a formidable challenge, resulting in severe morbidity and mortality [11]. To address our data, more than 2000 neurosurgical positive infections were reviewed in one of the largest neurosurgical centers of China and the incidence of neurosurgical bacterial meningitis/encephalitis was 7.6%.…”

Intraoperative lumbar drainage can prevent cerebrospinal fluid leakage during transsphenoidal surgery for pituitary adenomas: a systematic review and meta-analysis

“…(5) LD can reduce CSF leakage, but LD complication rates were reported as 3% for major and 5% for minor complications [ 24 ]. Complications included headache, nausea, and vomiting [ 25 , 26 ]; meningitis and other infections [ 27 , 28 ]; abducens palsy [ 29 ]; intracranial hypotension [ 30 ]; cerebellar tonsillar herniation [ 31 ]; intracranial venous thrombosis [ 32 ]; and lumbar nerve root irritation, retained catheters and pneumocephalus [ 20 ]. These complications can lead to higher costs, longer hospital stays, and most importantly, more suffering.…”

Infecção liquórica em drenagem ventricular externa: avaliação dos fatores de risco em 110 pacientes de uma única instituição

“…The concern about the risk factors that can determine CSF infection has grown in the world literature related to this subject. Among the several risk factors that are more frequently mentioned in the literature as relevant to CSF infection in patients submitted to EVD are the continuous monitoring of the ICP, 1,5 frequent manipulation, 1,6-8 collection techniques for regular laboratory evaluations, 9 prolonged permanence of the device, 2-4,7,9,12-14 concomitant infection, 13 the surgical technique used, CSF leak, 2,4,8,13,15 catheter change, 8 underlying diagnosis, as well as the factors related to the neurosurgical procedure of the treatment of the patients. 2,12 Despite the presence of some risk factors on the world literature, there is no consensus about which factors would be relevant, nor about the individual performance of each one of them in the many studies in which the topic is approached.…”

“…The main disadvantages of the permanence of these catheters are the potential risk of fatal ventriculitis and/or meningitis, and the mortality rate of the patients varies, reaching up to 45% according to a literature review. [1][2][3][4] Continuous monitoring of the ICP, 1,5 and continuous manipulation 1,[6][7][8] and frequent collection of CSF for laboratorial tests 9 are factors frequently related to the contamination of the derivation system of the CSF. Other risk factors are related to the long-term use of the ventricular catheter, such as presence of an infectious site at distance and the surgical technique.…”