Original Article

Clinical and microbiological spectrum of external ventricular drain related infections (EVDRIs) from a tertiary care center

Abstract

Background and Objectives: Insertion of an External Ventricular Drain (EVD) is a common and important lifesaving procedure that can lead to morbidity and mortality. This study was conducted to assess the infection rate, risk factors, causative organisms, and outcome of EVDs.
Materials and Methods: A prospective study was undertaken in a tertiary care centre from August 1st to October 30th, 2020. Over 192 patients had undergone insertion of EVDs in the neurosurgical intensive care unit. CSF samples were collected in sterile containers and transported to the laboratory.
Results: A total of 214 EVDs were inserted in 192 patients for 691 days. The median duration for EVD in situ and the mean time between catheter insertion and onset of infection were 14.5 days and 8 days. EVD related infection rate was 19.4 for 1000 EVD days. The most common risk factor for EVD insertion were tumors (55%) followed by hydrocephalus (40%).We identified 25 patients out of 192 (12%) who had clinical signs and symptoms with deranged CSF counts. A total of 13/25 (52%) specimens were culture positives out of which 10 (76.9%) were Gram negative pathogens and 3 (23%) were Gram positive pathogens and 3/10 (30%) Gram negative pathogens were Multidrug resistant organisms (MDROs).
Conclusion: It was observed that longer duration of catheter in situ was an important risk factor for EVD-related infections (ERIs) and also higher frequency of CSF sampling. A proper EVD infection prevention and control protocol must be followed in the form of a checklist at the time of EVD insertion.

1. Hagel S, BrunsT, Pletz MW, Engel C, Kalff R, Ewald C. External ventricular drain infections: risk factors and outcome. Interdiscip Perspect Infect Dis 2014; 2014: 708531.
2. Muralidharan R. External ventricular drains: management and complications. Surg Neurol Int 2015; 6(Suppl 6): S271-274.
3. Lwin S, Low SW, Choy DK, Yeo TT, Chou N. External ventricular drain infections: successful implementation of strategies to reduce infection rate. Singapore Med J 2012; 53: 255-259.
4. Flint AC, Rao VA, Renda NC, Faigeles BS, Lasman TE, Sheridan W. A simple protocol to prevent external ventricular drain infections. Neurosurgery 2013; 72:993-999.
5. Jamjoom AAB, Joannides AJ, Poon MT, Chari A, Zaben M, Abdulla MAH, et al. Prospective, multicentre study of external ventricular drainage-related infections in the UK and Ireland. J Neurol Neurosurg Psychiatry 2018; 89: 120-126.
6. Ramanan M, Lipman J, Shorr A, Shankar A. A meta-analysis of ventriculostomy-associated cerebrospinal fluid infections. BMC Infect Dis 2015; 15: 3.
7. Camacho EF, Boszczowski I, Basso M, Jeng BCP, Freire MP, GuimarãesT, et al. Infection rate and risk factors associated with infections related to external ventricular drain. Infection 2011; 39: 47-51.
8. Lyke KE, Obasanjo OO, Williams MA, O'Brien M, Chotani R, Perl TM. Ventriculitis complicating use of intraventricular catheters in adult neurosurgical patients. Clin Infect Dis 2001; 33: 2028-2033.
9. Lozier AP, Sciacca RR, Romagnoli MF, Connolly ES Jr. Ventriculostomy-related infections: a critical review of the literature. Neurosurgery 2002; 51: 170-181.
10. Le Guennec L, Coureuil M, Nassif X, Bourdoulous S. Strategies used by bacterial pathogens to cross the blood-brain barrier. Cell Microbiol 2020;22(1): e13132.
11. Kim JH, Desai NS, Ricci J, Stieg PE, Rosengart AJ, Härtl R, Fraser JF. Factors contributing to ventriculostomy infection. World Neurosurg 2012; 77: 135-140.
12. Omar MA, Mohd Haspani MS. The risk factors of external ventricular drainage related infection at hospital Kuala Lumpur: an observational study. Malays J Med Sci 2010; 17:48-54.
13. Schade RP, Schinkel J, Roelandse FW, Geskus RB, Visser LG, van Dijk JM, et al. Lack of value of routine analysis of cerebrospinal fluid for prediction and diagnosis of external drainage-related bacterial meningitis. J Neurosurg 2006; 104: 101-108.
14. Pfisterer W, Mühlbauer M, Czech T, Reinprecht A. Early diagnosis of external ventricular drainage infection : results of a prospective study. J Neurol Neurosurg Psychiatry 2003; 74: 929-932.
15. Lo CH, Spelman D, Bailey M, Cooper DJ, Rosenfeld JV, Brecknell JE. External ventricular drain infections are independent of drain duration: an argument against elective revision. J Neurosurg 2007; 106: 378-383.
16. Atkinson R, Fikrey L, Jones A, Pringle C, Patel HC. Cerebrospinal fluid infection associated with silver-impregnated external ventricular drain catheters. World Neurosurg 2016; 89: 505-509.
17. Hoefnagel D, Dammers R, Ter Laak-Poort MP, Avezaat CJ. Risk factors for infections related to external ventricular drainage. Acta Neurochir (Wien) 2008; 150: 209-214.
18. Gozal YM, Farley CW, Hanseman DJ, Harwell D, Magner M, Andaluz N, et al. Ventriculostomy-associated infection: a new, standardized reporting definition and institutional experience. Neurocrit Care 2014; 21: 147-151.
19. Beer R, Lackner P, Pfausler B, Schmutzhard E. Nosocomial ventriculitis and meningitis in neurocritical care patients. J Neurol 2008; 255: 1617-624.
20. Ortiz R, Lee K. Nosocomial infections in neurocritical care. Curr Neurol Neurosci Rep 2006; 6: 525-530.
21. Murphy RK, Liu B, Srinath A, Reynolds MR, Liu J, Craighead MC, et al. No additional protection against ventriculitis with prolonged systemic antibiotic prophylaxis for patients treated with antibiotic-coated external ventricular drains. J Neurosurg 2015; 122: 1120-1126.
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IssueVol 14 No 2 (2022) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijm.v14i2.9183
Keywords
Cerebral ventriculitis; Infection control; Hydrocephalus; Intracranial pressure; Brain neoplasms

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How to Cite
1.
Mehreen S, Padmaja K, Sudhaharan S, Teja V, Saradhi M, Krishna Y. Clinical and microbiological spectrum of external ventricular drain related infections (EVDRIs) from a tertiary care center. Iran J Microbiol. 2022;14(2):168-173.