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

Citation

Jamjoom, A., Joannides, A., Poon, M., Chari, A., Zaben, M., Abdullah, M., …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