E-ISSN: 1019-5157
ISSN: 2651-5024
Research
EXTRAVENTRICULAR DRAIN-ASSOCIATED INFECTION RATES AND RISK FACTORS: AN 8-YEAR EXPERIENCE
Türkkan Öztürk Kaygusuz✉ ,
Bilal Ertuğrul ,
Ayşe Sağmak Tartar ,
Ayhan Akbulut ,
Metin Kaplan ,
Kutbeddin Demirdağ ,
Selman Kök
Bilal Ertuğrul ,
Ayşe Sağmak Tartar ,
Ayhan Akbulut ,
Metin Kaplan ,
Kutbeddin Demirdağ ,
Selman Kök
Beyin ve sinir cerrahisi, Fırat üniversitesi
DOI: 10.5137/1019-5149.JTN.49278-25.4
Article in Press
Corresponding Author:
Türkkan Öztürk Kaygusuz (turkkan69@gmail.com)
Abstract
Aim
Infections associated with extra-ventricular drains (EVDs) remain a major challenge in neurosurgical care. This retrospective single-center study evaluated the infection rate, causative microorganisms, resistance patterns, and clinical risk factors associated with EVD- associated infections (EVD-AI) over an eight-year period.
Material and Methods
Medical records of 192 patients who underwent EVD insertion between 2014 and 2022 were reviewed. Demographic, clinical, and microbiological data were analyzed. EVD-AI was defined according to the 2017 IDSA guidelines
Results
Among the 125 patients included in the study, 25 episodes of EVD-AI occurred in 22 patients (20%). The incidence of EVD-AI was significantly higher in catheters inserted for infection (60%) and traumatic subarachnoid hemorrhage (50%) (p = 0.004). The risk of infection was significantly greater in patients with prolonged catheterization (median 17 vs. 10 days), those who underwent ≥3 EVD insertions, and those with ≥3 cerebrospinal fluid (CSF) samplings (p < 0.001). Logistic regression analysis identified ≥3 CSF samplings as an independent predictor of infection (OR = 6.25). No difference in infection rates was observed between patients who received prophylaxis for more than one day and those who received it for a single day (p = 0.479). Gram-negative pathogens accounted for 80% of the isolates, predominantly Acinetobacter spp. (44%) and Klebsiella spp. (24%), both exhibiting multidrug resistance.
Conclusion
EVD-AI is a severe but preventable complication. Minimizing unnecessary EVD insertions, limiting CSF sampling, and adhering to local antimicrobial surveillance can reduce infection rates. These data provide practical insights for improving infection control and antibiotic stewardship in neurosurgical units.
Infections associated with extra-ventricular drains (EVDs) remain a major challenge in neurosurgical care. This retrospective single-center study evaluated the infection rate, causative microorganisms, resistance patterns, and clinical risk factors associated with EVD- associated infections (EVD-AI) over an eight-year period.
Material and Methods
Medical records of 192 patients who underwent EVD insertion between 2014 and 2022 were reviewed. Demographic, clinical, and microbiological data were analyzed. EVD-AI was defined according to the 2017 IDSA guidelines
Results
Among the 125 patients included in the study, 25 episodes of EVD-AI occurred in 22 patients (20%). The incidence of EVD-AI was significantly higher in catheters inserted for infection (60%) and traumatic subarachnoid hemorrhage (50%) (p = 0.004). The risk of infection was significantly greater in patients with prolonged catheterization (median 17 vs. 10 days), those who underwent ≥3 EVD insertions, and those with ≥3 cerebrospinal fluid (CSF) samplings (p < 0.001). Logistic regression analysis identified ≥3 CSF samplings as an independent predictor of infection (OR = 6.25). No difference in infection rates was observed between patients who received prophylaxis for more than one day and those who received it for a single day (p = 0.479). Gram-negative pathogens accounted for 80% of the isolates, predominantly Acinetobacter spp. (44%) and Klebsiella spp. (24%), both exhibiting multidrug resistance.
Conclusion
EVD-AI is a severe but preventable complication. Minimizing unnecessary EVD insertions, limiting CSF sampling, and adhering to local antimicrobial surveillance can reduce infection rates. These data provide practical insights for improving infection control and antibiotic stewardship in neurosurgical units.
Keywords
ventriculitis
meningitis
extraventricular drainage
central nervous system infections
neurosurgery