Is External Ventricular Drain Infection Predictable in Neurosurgery Patients? A Following-up Study in Iran

Background: External ventricular drains (EVDs) infection is a life-threatening complication. Objectives: To investigate the rate of EVDs infection and its predictive factors in neurosurgery patients hospitalized at a tertiary teaching hospital in Iran. Methods: In this survey, all patients referred to a subspecialty hospital in Tehran (Iran) with an external ventricular drain (EVDs) from Jun 23, 2018, to Jun 23, 2019, are monitored within 30 days of EVDs placement for infection. Data on demographic information, underlying diseases, number of EVD replacements, length of hospital stay, type consumed antibiotic before neurosurgery, length of tunneling, type of airway, duration of mechanical ventilation, duration of surgery(hours), surgeon name, APACHE II score, length of intensive care unit stay are collected. The diagnosis was based on the Center for Diseases Control and Prevention criteria for meningitis/ventriculitis and clinical vision of infectious or critical care specialists. A logistic regression model was developed to identify factors that can predict the infection. Results: Of 81 patients with EVDs, 39 (48.1%) were infected. The mean age of patients was 44.33 ± 19.5 years, and 55.6% of them were male. According to the multiple logistic regression analysis, mechanical ventilation for more than 6 days (OR: 2.5, 95% CI: 1.6 - 3.56, P = 0.04) and length of tunneling > 5 cm (OR: 1.98, 95%CI: 1.87 - 4.76, P = 0.02) were identified as factors that could predict EVD infection. Also, consuming ceftazidime + vancomycin, as a prophylaxis agent, had a lower odds ratio for EVD infection (OR:0.4, 95% CI: 0.08 - 0.84, P = 0.04). Conclusions: Regarding the predictive factors of EVDs infection, either in the present study or other studies, there should be strategies to manage this life-threatening infection in neurosurgery patients.