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Microbiological spectrum of organisms in patients undergoing external ventricular drain insertion at a tertiary care
Mahrukh Afreen1, Syed Vaqar Hussain1, Aleezay Irfan2
1Department of Neurosurgery, Shifa International Hospital.
Objectives:
To assess the incidence, causative pathogens, and impact of external ventricular drain-related infection on disease prognosis.
Methods:
The observational, cross-sectional study was conducted from September 2022 to March 2023 after obtaining approval from the ethics review board of Shifa International Hospital, Islamabad, Pakistan, and comprised patients having no prior cerebrospinal fluid infection. The patients underwent external ventricular drain administration as part of their treatment. Unneeded antibiotics or cerebrospinal fluid sampling before removing the drain were avoided. External ventricular drain-related infection was defined as pathogenic growth on one or more cerebrospinal fluid culture/sensitivity test post-insertion of the drain. Data was analysed using SPSS 26.
Results:
Of the 74 patients, 42(56.8%) were males and 32(43.2%) were females. Overall, 25(33.8%) patients were aged 20-50 years. A total of 86 external ventricular drain were inserted for a mean period of 10.77+/-7.42 days (range: 1-40), with a total of 797 catheter days. Hydrocephalus 21(28.4%) and tumours 20(27%) were the most common aetiologies for external ventricular drain, but no significant aetiological risk factors for external ventricular drain-related infection were identified (p>0.05). Overall, 39(52.7%) patients recovered with external ventricular drain removal, and 12(16.2%) needed a shunt. External ventricular drain-related infection developed in 12(16.2%) patients (95% confidence interval: 4.15-4.75), having external ventricular drain for a mean period of 14.92+/-10.5 days (range 5-40) and 179 total catheter days. Coagulase-negative staphylococcus epidermidis was found in 4(33.3%) and it was sensitive to vancomycin, followed by Klebsiella pneumoniae and Pseudomonas aeruginosa 2(16.7%) each, and they were sensitive to amikacin and colistin, respectively. External ventricular drain-related infection was associated with poor outcomes (p=0.04), a longer intensive care unit stay (p<0.05), a longer hospital stay (p<0.05), and a longer external ventricular drain in-situ (p=0.05).
Conclusion:
Aseptic external ventricular drain placement and its early removal could avoid external ventricular drain-related infections.
Insights
External ventricular drain infections occurred in 16.2% of patients, associated with poorer outcomes and longer hospital stays. Aseptic placement and early removal of external ventricular drains can help prevent these infections.
Area of Science:
- Neurosurgery
- Infectious Diseases
- Critical Care Medicine
Background:
- External ventricular drains (EVDs) are crucial for managing cerebrospinal fluid (CSF) issues.
- EVD-related infections pose significant risks to patient recovery and prognosis.
- Understanding the incidence and impact of EVD infections is vital for improving patient care.
Purpose of the Study:
- To determine the incidence of external ventricular drain-related infections.
- To identify causative pathogens and their antibiotic sensitivities.
- To assess the impact of EVD infections on patient outcomes.
Main Methods:
- An observational, cross-sectional study was conducted with 74 patients undergoing EVD insertion.
- Patients with prior CSF infections were excluded.
- EVD-related infection was defined by positive CSF cultures post-insertion; data analyzed using SPSS 26.
Main Results:
- The incidence of EVD-related infection was 16.2%, with coagulase-negative Staphylococcus epidermidis being the most common pathogen.
- Infections were associated with significantly longer intensive care unit and hospital stays, and prolonged EVD in-situ duration.
- No significant etiological risk factors for EVD infection were identified (p>0.05).
Conclusions:
- EVD-related infections are linked to adverse patient outcomes, including extended hospital stays.
- Preventive measures such as aseptic EVD placement and timely removal are recommended.
- Effective antibiotic management, guided by culture sensitivity, is crucial for treating identified pathogens.
