A prospective, multicentre study of external ventricular drainage-related infections in the United Kingdom and Ireland

Jamjoom, A.A.B.; Joannides, A.; Poon, M.; Chari, A.; Zaben, M.; Abdullah, M.A.H.; Roach, J.; Glancz, L.J.; Solth, A.; Duddy, J.; Brennan, P.M.; Bayston, Roger; Bulters, D.O.; Mallucci, C.; Jenkinson, M.D.; Gray, W.P.; Kandamsay, J.; Hutchinson, P.J.; Kolias, A.G.; Ahmed, A.I.

Abstract

Objectives

External Ventricular Drain (EVD) insertion is a common neurosurgical procedure. EVD- related 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.

Citation

Jamjoom, A., Joannides, A., Poon, M., Chari, A., Zaben, M., Abdullah, M., Roach, J., Glancz, L., Solth, A., Duddy, J., Brennan, P., Bayston, R., Bulters, D., Mallucci, C., Jenkinson, M., Gray, W., Kandamsay, J., Hutchinson, P., Kolias, A., & Ahmed, A. (2018). A prospective, multicentre study of external ventricular drainage-related infections in the United Kingdom and Ireland. Journal of Neurology, Neurosurgery and Psychiatry, 89, https://doi.org/10.1136/jnnp-2017-316415

• Journal Article Type: Article
• Acceptance Date: Oct 5, 2017
• Online Publication Date: Oct 25, 2017
• Publication Date: Jan 15, 2018
• Deposit Date: Oct 12, 2017
• Publicly Available Date: Oct 25, 2017
• Journal: Journal of Neurology, Neurosurgery and Psychiatry
• Print ISSN: 0022-3050
• Electronic ISSN: 1468-330X
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 89
• DOI: https://doi.org/10.1136/jnnp-2017-316415
• Keywords: External ventricular drainage, Infection, Impregnated catheter, Multi centre study
• Public URL: https://nottingham-repository.worktribe.com/output/904681
• Publisher URL: http://jnnp.bmj.com/content/89/2/120.info
• Contract Date: Oct 12, 2017