Impact of an external ventricular shunt (EVD) handling protocol on secondary meningitis rates: a historical cohort study with propensity score matching

BMC Neurology

Research Article

Anne F. Voor in’t Holt¹  Margreet C. Vos¹  Clemens M. F. Dirven²  Daphna Hoefnagel²  Ruben Dammers²  Victor Volovici³  Ellianne J. dos Santos Rubio⁴ 

[1] Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, the Netherlands;Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Center, Doctor Molewaterplein 40 Room-#: Na-2112, 3015 GD, Rotterdam, the Netherlands;Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Center, Doctor Molewaterplein 40 Room-#: Na-2112, 3015 GD, Rotterdam, the Netherlands;Department of Public Health, Center for Medical Decision Making, Erasmus MC University Medical Center, Rotterdam, the Netherlands;Department of Neurosurgery, St. Elisabeth Hospital, Willemstad, Curaçao;

关键词: External ventricular drainage;    EVD handling protocol;    Meningitis;    Ventriculitis;    Central nervous system infection;    Protocol;    Quality improvement;   

DOI  :  10.1186/s12883-023-03080-2

 received in 2022-05-31, accepted in 2023-01-11,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundExternal ventricular drainage (EVD) is frequently used in neurosurgical procedures for cerebrospinal fluid (CSF) drainage. It is, however, associated with high infection rates, namely secondary meningitis and ventriculitis. Based on a previous high prevalence of these infections among patients with EVDs, we have proposed and implemented a protocol in an effort to decrease the infection rate. The aim of this study was to measure the effect of hospital-wide implementation of the EVD handling protocol on secondary EVD infections.Patients and methodsWe included 409 consecutive patients who received a new EVD for other indications than infectious pathologies from January 2000 until June 2012. Patients above 18 years of age were divided into pre- (n = 228) and post-protocol (n = 181) groups. Patient and disease demographics, as well as EVD data together with confounders for secondary meningitis were recorded in a database. Propensity score matching was then performed to create groups matched for sex, age, reason for drainage, type of shunt, time in situ and duration of surgery to place the EVD. Binomial logistic regression for confounder adjustment and regression discontinuity analyses were then performed on the matched cohort.ResultsInfections occurred more frequently in the pre-protocol group (23% vs 9%, p <  0.001). The incidence of infection was 33/1000 drain-days pre-protocol and 9/1000 drain-days post-protocol. Regression analysis in a propensity score-matched cohort (n = 103 in the pre- and n = 178 in the post-protocol groups) showed that the pre-protocol period was independently associated with more infections (OR 2.69; 95%-CI 1.22–5.95, p = 0.01).ConclusionsThe incidence of secondary EVD infections can be reduced significantly by the implementation of a strict hospital-wide EVD handling protocol.

【 授权许可】

CC BY   
© The Author(s) 2023