External Ventricular Drainage Infections: A Single-Centre Experience on 100 Cases

Abstract

Objective: The aim of the study was to identify the frequency of EVD infection, the risk factors for infection, the effect of infection to final outcome and to VP shunt insertion rate. Methods: We retrospectively analysed 100 patients with EVD admitted to the Neurological ICU in the period from January 2013 to December 2014. Results: The median age of the patients was 60.8 years (range 18-86 years), 53% were male and 47% were female. The underlying pathologies were: subarachnoid haemorrhage 53/100 (53%), intracerebral haematoma 43/100 (43%), tumour 3/100 (3%) and cerebral infarction 1/100 (1%). 33/100 (33%) received a conservative treatment, 40/100 (40%) a endovascular treatment and 29/100 (29%) a surgical treatment. 13/100 (13%) of the patients had an EVD infection. Statistical analysis showed no significant correlation between infection and age, underlying pathology and surgical treatment. There was a significant relationship between infection and longer EVD duration, multiple EVD replacements and multiple burr-holes. We classified the outcome at 6 months using the modified Rankin scale. The patients were divided into two groups: bad outcome (scores 3, 4, 5, 6) and good outcome (scores 0, 1, 2). There was a significant correlation between age and bad outcome, but not between infection and bad outcome. 12 (13.7%) patients without infection and 2 (15.3%) patients with infection needed a permanent VP shunt. This difference was not statistically significant. Conclusion: Infection is a potentially dangerous complication of EVD. We found an infection rate of 13%, which is comparable with other literature reports. We noticed no correlation between infection and age, primary pathology or type of treatment. An EVD infection, if recognized soon and adequately treated, did not significantly affect the final outcome and the VPD insertion rate.