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Updated: Apr 18, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
A meta-analysis of ventriculostomy-associated cerebrospinal fluid infections
Mahesh Ramanan1,2, Jeffrey Lipman3,4, Andrew Shorr5
1Burns Trauma Critical Care Research Centre, School of Medicine, University of Queensland, Brisbane, Queensland, Australia. ramanan.mahesh@gmail.com.
Background:
Ventriculostomy insertion is a common neurosurgical intervention and can be complicated by ventriculostomy-associated cerebrospinal fluid infection (VAI) which is associated with increased morbidity and mortality. This meta-analysis was aimed at determining the pooled incidence rate (number per 1000 catheter-days) of VAI.
Methods:
Relevant studies were identified from MEDLINE and EMBASE and from reference searching of included studies and recent review articles on relevant topics. The Newcastle-Ottawa Scale was used to assess quality and risk of bias. A random effects model was used to pool individual study estimates and 95% confidence intervals (CI) were calculated using the exact Poisson method. Heterogeneity was assessed using the heterogeneity χ2 and I-squared tests. Subgroup analyses were performed and a funnel plot constructed to assess publication bias.
Results:
There were a total of 35 studies which yielded 752 infections from 66,706 catheter-days of observation. The overall pooled incidence rate of VAI was 11.4 per 1000 catheter days (95% CI 9.3 to 13.5), for high quality studies the rate was 10.6 (95% CI 8.3 to 13) and 13.5 (95% CI 8.9 to 18.1) for low quality studies. Studies which had mean duration of EVD treatment of less than 7 days had a pooled VAI rate of 19.6 per 1000 catheter-days, those with mean duration of 7-10 days had VAI rate of 12.8 per 1000 catheter-days and those with mean duration greater than 10 days had VAI rate of 8 per 1000 catheter-days. There was significant heterogeneity for the primary outcome (p = 0.004, I-squared = 44%) and most subgroups. The funnel plot did not show evidence for publication bias.
Conclusions:
The incidence rate of VAI is 11.4 per 1000 catheter-days. Further research should focus on analysis of risk factors for VAI and techniques for reducing the rate of VAI.
Insights
Ventriculostomy-associated infection (VAI) occurs in 11.4 per 1000 catheter-days. Shorter external ventricular drain (EVD) durations are linked to higher VAI rates, emphasizing the need for risk factor research.
Area of Science:
- Neurosurgery
- Infectious Disease Epidemiology
Background:
- Ventriculostomy insertion is a common neurosurgical procedure.
- Ventriculostomy-associated infection (VAI) increases patient morbidity and mortality.
Purpose of the Study:
- To determine the pooled incidence rate of VAI.
- To analyze VAI rates based on study quality and external ventricular drain (EVD) duration.
Main Methods:
- A meta-analysis of 35 studies was conducted.
- Data from MEDLINE and EMBASE were systematically reviewed.
- Random effects modeling was used to pool incidence rates.
Main Results:
- The overall pooled incidence rate of VAI was 11.4 per 1000 catheter-days.
- Higher VAI rates were observed in studies with shorter mean EVD durations (<7 days: 19.6/1000 catheter-days).
- No significant publication bias was detected.
Conclusions:
- The overall incidence of VAI is 11.4 per 1000 catheter-days.
- Further research should identify VAI risk factors and reduction strategies.
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