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Abstract
Background and Objectives External ventricular drainage (EVD) is one of the most commonly performed neurosurgical procedures, but EVD-related infection constitutes a significant health concern. Yet, little consensus identifies the risk factors for the development of EVD-related infection. Therefore, we performed a meta-analysis to systematically summarize existing evidence on the incidence and risk factors for EVD-related infection.
Methods PubMed, Embase, and the Cochrane Library databases from database inception to February 28, 2022, were searched for all studies investigating the incidence and risk factors for EVD-related infection. Data were assessed by R-4.2.0 software. The meta-analysis was used to calculate pooled odds ratios (OR) and 95% confidence intervals (CI).
Results A total of 48 studies were included. Among the 29 factors analyzed, statistically significant risk factors were subarachnoid hemorrhage(SAH)/intraventricular hemorrhage(IVH) (OR = 1.48, 95% CI = 1.20–1.82, p < 0.001), concomitant systemic infection (OR = 1.90, 95% CI = 1.34–2.70, p < 0.001), other neurosurgical procedures (OR = 1.76, 95% CI = 1.02–3.04, p = 0.041), change of catheter (OR = 5.05, 95% CI = 3.67–6.96, p < 0.001), bilateral EVDs (OR = 2.25, 95% CI = 1.03–4.89, p = 0.041), (cerebrospinal fluid) CSF leak (OR = 3.19, 95% CI = 2.12–4.81, p < 0.001) and duration of EVD >7 days (OR = 4.62, 95% CI = 2.26–9.43, p < 0.001). The use of silver-coated catheters (OR = 0.57, 95% CI = 0.38–0.87, p = 0.008) and antibiotic-impregnated catheters (OR = 0.60, 95% CI = 0.41–0.88, p = 0.009) might help reduce the risk of infection. No significant difference was indicated in studies evaluating factors like diabetes mellitus (OR = 1.25, 95% CI = 0.90–1.75, p = 0.178), steroids used (OR = 1.52, 95% CI = 0.96–2.4, p = 0.074), prophylactic antibiotics(OR = 0.87, 95% CI = 0.66–1.14, p = 0.308).
Discussion The meta-analysis of various relevant factors in the onset of EVD-related infection in patients submitted to EVD enabled us to establish a more probable profile of the patients who are more likely to develop it during the treatment.
Footnotes
Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.
Submitted and externally peer reviewed. The handling editor was Deputy Editor Kathryn Kvam, MD.
- Received June 6, 2022.
- Accepted February 21, 2023.
- © 2023 American Academy of Neurology
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