Risk Assessment and Recommended Approaches to Optimize Infection Control and Antibiotic Stewardship to Reduce External Ventricular Drain Infection: A Single-Center Study
<b>Background:</b> An external ventricular drain (EVD) is used to release elevated intracranial pressure by draining cerebrospinal fluid (CSF) from the brain’s ventricles. The establishment of an EVD is one of the most commonly performed neurosurgical procedures to treat intracranial pre...
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MDPI AG
2024-11-01
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| author | Jozsef Kelemen Marton Sztermen Eva Dakos Gergely Agocs Jozsef Budai Jozsef Katona Zsuzsanna Szekeressy Laszlo Sipos Zoltan Papp Mate Bata Janos Karczub Mate Korompai Zsuzsanna A. Dunai Bela Kocsis Dora Szabo Lorand Eross |
| author_facet | Jozsef Kelemen Marton Sztermen Eva Dakos Gergely Agocs Jozsef Budai Jozsef Katona Zsuzsanna Szekeressy Laszlo Sipos Zoltan Papp Mate Bata Janos Karczub Mate Korompai Zsuzsanna A. Dunai Bela Kocsis Dora Szabo Lorand Eross |
| author_sort | Jozsef Kelemen |
| collection | DOAJ |
| description | <b>Background:</b> An external ventricular drain (EVD) is used to release elevated intracranial pressure by draining cerebrospinal fluid (CSF) from the brain’s ventricles. The establishment of an EVD is one of the most commonly performed neurosurgical procedures to treat intracranial pressure in patients. Nevertheless, infections are very frequent complications. Identifying the risk factors for EVD-related infections is a key to improving patient safety and outcomes. <b>Methods:</b> We conducted a retrospective, single-center study of patients who underwent EVD implantation between January 2022 and March 2024. Patients were classified into infected and non-infected groups based on their clinical symptoms, as well as laboratory and microbiological results. Patient characteristics and possible risk factors for infection were compared between the two groups. <b>Results:</b> In total, 123 patients treated with 156 EVDs were included in this study, with a mean age of 55.8 (range: 25–84) years. EVD-associated infections were observed in 37 patients (30%). We found no significant association between infection risk and patient characteristics, including gender, primary diagnosis, craniotomy, or immunosuppression. There was no significant difference in terms of EVD insertion, i.e., whether the insertion took place in the operating room (OR) with antibiotic prophylaxis or outside the OR with no periprocedural antibiotic treatment. However, within the intensive care unit (ICU), EVD infection was much lower (13%) if EVD insertion took place in a single-bed room compared to multiple-bed room insertions (34%). Furthermore, there were significant differences in terms of the duration of first EVD (both single and multiple catheterizations) (<i>p</i> < 0.0001) and the total catheterization time (<i>p</i> = 0.0001). Additionally, there was a significant association with patient days in the ICU and EVD catheterization. <b>Conclusions:</b> Revisiting infection control measures is necessary, with special attention to the replacement of EVDs in single-bed ICU rooms, to introduce antibiotic prophylaxis in the ICU. Minimizing unnecessary EVD manipulation during catheterization is crucial in order to decrease the risk of EVD infection. |
| format | Article |
| id | doaj-art-42bbd86d681e41b7b06ee20c1546e8a4 |
| institution | OA Journals |
| issn | 2079-6382 |
| language | English |
| publishDate | 2024-11-01 |
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| series | Antibiotics |
| spelling | doaj-art-42bbd86d681e41b7b06ee20c1546e8a42025-08-20T02:26:47ZengMDPI AGAntibiotics2079-63822024-11-011311109310.3390/antibiotics13111093Risk Assessment and Recommended Approaches to Optimize Infection Control and Antibiotic Stewardship to Reduce External Ventricular Drain Infection: A Single-Center StudyJozsef Kelemen0Marton Sztermen1Eva Dakos2Gergely Agocs3Jozsef Budai4Jozsef Katona5Zsuzsanna Szekeressy6Laszlo Sipos7Zoltan Papp8Mate Bata9Janos Karczub10Mate Korompai11Zsuzsanna A. Dunai12Bela Kocsis13Dora Szabo14Lorand Eross15Deparment of Neurosurgery and Neurointervention, Semmelweis University, 1085 Budapest, HungaryDeparment of Neurosurgery and Neurointervention, Semmelweis University, 1085 Budapest, HungaryDeparment of Neurosurgery and Neurointervention, Semmelweis University, 1085 Budapest, HungaryDepartment of Biophysics and Radiation Biology, Semmelweis University, 1094 Budapest, HungaryDeparment of Neurosurgery and Neurointervention, Semmelweis University, 1085 Budapest, HungaryDeparment of Neurosurgery and Neurointervention, Semmelweis University, 1085 Budapest, HungaryGyula Nyírő National Institute of Psychiatry and Addiction, 1135 Budapest, HungaryDeparment of Neurosurgery and Neurointervention, Semmelweis University, 1085 Budapest, HungaryDeparment of Neurosurgery and Neurointervention, Semmelweis University, 1085 Budapest, HungaryDeparment of Neurosurgery and Neurointervention, Semmelweis University, 1085 Budapest, HungaryDeparment of Neurosurgery and Neurointervention, Semmelweis University, 1085 Budapest, HungaryDeparment of Neurosurgery and Neurointervention, Semmelweis University, 1085 Budapest, HungaryHUN-REN-SU Human Microbiota Research Group, 1052 Budapest, HungaryInstitute of Medical Microbiology, Semmelweis University, 1089 Budapest, HungaryDeparment of Neurosurgery and Neurointervention, Semmelweis University, 1085 Budapest, HungaryDeparment of Neurosurgery and Neurointervention, Semmelweis University, 1085 Budapest, Hungary<b>Background:</b> An external ventricular drain (EVD) is used to release elevated intracranial pressure by draining cerebrospinal fluid (CSF) from the brain’s ventricles. The establishment of an EVD is one of the most commonly performed neurosurgical procedures to treat intracranial pressure in patients. Nevertheless, infections are very frequent complications. Identifying the risk factors for EVD-related infections is a key to improving patient safety and outcomes. <b>Methods:</b> We conducted a retrospective, single-center study of patients who underwent EVD implantation between January 2022 and March 2024. Patients were classified into infected and non-infected groups based on their clinical symptoms, as well as laboratory and microbiological results. Patient characteristics and possible risk factors for infection were compared between the two groups. <b>Results:</b> In total, 123 patients treated with 156 EVDs were included in this study, with a mean age of 55.8 (range: 25–84) years. EVD-associated infections were observed in 37 patients (30%). We found no significant association between infection risk and patient characteristics, including gender, primary diagnosis, craniotomy, or immunosuppression. There was no significant difference in terms of EVD insertion, i.e., whether the insertion took place in the operating room (OR) with antibiotic prophylaxis or outside the OR with no periprocedural antibiotic treatment. However, within the intensive care unit (ICU), EVD infection was much lower (13%) if EVD insertion took place in a single-bed room compared to multiple-bed room insertions (34%). Furthermore, there were significant differences in terms of the duration of first EVD (both single and multiple catheterizations) (<i>p</i> < 0.0001) and the total catheterization time (<i>p</i> = 0.0001). Additionally, there was a significant association with patient days in the ICU and EVD catheterization. <b>Conclusions:</b> Revisiting infection control measures is necessary, with special attention to the replacement of EVDs in single-bed ICU rooms, to introduce antibiotic prophylaxis in the ICU. Minimizing unnecessary EVD manipulation during catheterization is crucial in order to decrease the risk of EVD infection.https://www.mdpi.com/2079-6382/13/11/1093central nervous system (CNS)hospital-acquired infectionneurosurgeryexternal ventricular drain (EVD)EVD infectionpost-neurosurgical meningitis |
| spellingShingle | Jozsef Kelemen Marton Sztermen Eva Dakos Gergely Agocs Jozsef Budai Jozsef Katona Zsuzsanna Szekeressy Laszlo Sipos Zoltan Papp Mate Bata Janos Karczub Mate Korompai Zsuzsanna A. Dunai Bela Kocsis Dora Szabo Lorand Eross Risk Assessment and Recommended Approaches to Optimize Infection Control and Antibiotic Stewardship to Reduce External Ventricular Drain Infection: A Single-Center Study Antibiotics central nervous system (CNS) hospital-acquired infection neurosurgery external ventricular drain (EVD) EVD infection post-neurosurgical meningitis |
| title | Risk Assessment and Recommended Approaches to Optimize Infection Control and Antibiotic Stewardship to Reduce External Ventricular Drain Infection: A Single-Center Study |
| title_full | Risk Assessment and Recommended Approaches to Optimize Infection Control and Antibiotic Stewardship to Reduce External Ventricular Drain Infection: A Single-Center Study |
| title_fullStr | Risk Assessment and Recommended Approaches to Optimize Infection Control and Antibiotic Stewardship to Reduce External Ventricular Drain Infection: A Single-Center Study |
| title_full_unstemmed | Risk Assessment and Recommended Approaches to Optimize Infection Control and Antibiotic Stewardship to Reduce External Ventricular Drain Infection: A Single-Center Study |
| title_short | Risk Assessment and Recommended Approaches to Optimize Infection Control and Antibiotic Stewardship to Reduce External Ventricular Drain Infection: A Single-Center Study |
| title_sort | risk assessment and recommended approaches to optimize infection control and antibiotic stewardship to reduce external ventricular drain infection a single center study |
| topic | central nervous system (CNS) hospital-acquired infection neurosurgery external ventricular drain (EVD) EVD infection post-neurosurgical meningitis |
| url | https://www.mdpi.com/2079-6382/13/11/1093 |
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