Abstract：
BACKGROUND: Device-associated CNS infections is a major subgroup of healthcare associated CNS infections. Healthcare-associated ventriculitis or meningitis differs considerably from community-acquired meningitis in its epidemiology, pathogenesis, clinical presentation and management.
OBJECTIVE: This study aimed to identify the infection rates, the associated risk factors, and outcomes of these life-threatening infections.
METHODS: This was a 2-year single center prospective cohort study. Patient\'s clinical data, laboratory parameters, treatment and their outcomes were collected using data collection tool, and device days were collected from the hospital information system (HIS). Patients were categorised using IDSA criteria as contamination or colonisation or infection. Cox regression model was used for multivariate analysis to estimate hazard risk.
RESULTS: A total of 578 CSF diversion catheters were inserted in 472 patients. The average rate for EVD and LD infection were 11.12 and 11.86 per 1000 device days respectively. The average infection rates for VP and LP shunts were 6% and 5.2% per procedure, respectively. The commonest etiological agent causing CSF diversion catheter-related infection (CDRI) was Klebsiella pneumoniae (n = 14, 40%). The risk factors which were independently associated with increased infection risk by cox regression analysis were drain insertion ≥7 days [HR:11.73, p -0.03], posterior approach of EVD insertion (occipital) [HR:9.53, p - 0.01], pre-OP ASA score>3 [HR:8.28, p - 0.013] presence of EVD/LD leak [HR: 17.24, p < 0.0001], male gender [HR:2.05, p-0.05] and presence of associated peri-operative scalp infections [HR:3.531, p-0.005]. Shift to narrow spectrum surgical prophylactic antibiotic [Coefficient: -1.284, p-0.03] and reduction in CSF sampling frequency [Coefficient: -1.741, p-0.02] were found to be negatively associated with CDRI.
CONCLUSIONS: The study demonstrated drain insertion ≥7 days, posterior approach of EVD insertion, presence of EVD/LD leak, male gender and presence of associated peri-operative scalp skin and soft tissue infections were associated with increased risk of infection.
OBJECTIVE: This study aimed to identify the infection rates, the associated risk factors, and outcomes of these life-threatening infections.
METHODS: This was a 2-year single center prospective cohort study. Patient\'s clinical data, laboratory parameters, treatment and their outcomes were collected using data collection tool, and device days were collected from the hospital information system (HIS). Patients were categorised using IDSA criteria as contamination or colonisation or infection. Cox regression model was used for multivariate analysis to estimate hazard risk.
RESULTS: A total of 578 CSF diversion catheters were inserted in 472 patients. The average rate for EVD and LD infection were 11.12 and 11.86 per 1000 device days respectively. The average infection rates for VP and LP shunts were 6% and 5.2% per procedure, respectively. The commonest etiological agent causing CSF diversion catheter-related infection (CDRI) was Klebsiella pneumoniae (n = 14, 40%). The risk factors which were independently associated with increased infection risk by cox regression analysis were drain insertion ≥7 days [HR:11.73, p -0.03], posterior approach of EVD insertion (occipital) [HR:9.53, p - 0.01], pre-OP ASA score>3 [HR:8.28, p - 0.013] presence of EVD/LD leak [HR: 17.24, p < 0.0001], male gender [HR:2.05, p-0.05] and presence of associated peri-operative scalp infections [HR:3.531, p-0.005]. Shift to narrow spectrum surgical prophylactic antibiotic [Coefficient: -1.284, p-0.03] and reduction in CSF sampling frequency [Coefficient: -1.741, p-0.02] were found to be negatively associated with CDRI.
CONCLUSIONS: The study demonstrated drain insertion ≥7 days, posterior approach of EVD insertion, presence of EVD/LD leak, male gender and presence of associated peri-operative scalp skin and soft tissue infections were associated with increased risk of infection.
摘要：
背景：装置相关CNS感染是医疗保健相关CNS感染的主要亚组。医疗保健相关的脑室炎或脑膜炎在流行病学上与社区获得性脑膜炎有很大不同，发病机制，临床表现和管理。
目的：本研究旨在确定感染率，相关的危险因素，以及这些危及生命的感染的结果。
方法：这是一项为期2年的单中心前瞻性队列研究。患者的临床数据，实验室参数,使用数据收集工具收集治疗和结果，和设备天数从医院信息系统(HIS)收集.使用IDSA标准将患者分类为污染或定植或感染。Cox回归模型用于多变量分析以估计危险风险。
结果：472例患者共插入578根脑脊液分流导管。EVD和LD的平均感染率分别为每1000天11.12和11.86。VP和LP分流的平均感染率为每次手术的6%和5.2%，分别。引起CSF改道导管相关性感染（CDRI）的最常见病原体是肺炎克雷伯菌（n=14，40％）。通过cox回归分析，与感染风险增加独立相关的危险因素是引流管插入≥7天[HR：11.73，p-0.03]，EVD后路插入（枕骨）[HR：9.53，p-0.01]，术前ASA评分>3[HR：8.28，p-0.013]存在EVD/LD泄漏[HR：17.24，p<0.0001]，男性[HR：2.05，p-0.05]和相关的围手术期头皮感染的存在[HR：3.531，p-0.005]。发现转向窄谱手术预防性抗生素[系数：-1.284，p-0.03]和CSF采样频率降低[系数：-1.741，p-0.02]与CDRI呈负相关。
结论：研究表明引流管插入≥7天，EVD后路插入,存在EVD/LD泄漏，男性和围手术期头皮皮肤和软组织感染的存在与感染风险增加相关.
目的：本研究旨在确定感染率，相关的危险因素，以及这些危及生命的感染的结果。
方法：这是一项为期2年的单中心前瞻性队列研究。患者的临床数据，实验室参数,使用数据收集工具收集治疗和结果，和设备天数从医院信息系统(HIS)收集.使用IDSA标准将患者分类为污染或定植或感染。Cox回归模型用于多变量分析以估计危险风险。
结果：472例患者共插入578根脑脊液分流导管。EVD和LD的平均感染率分别为每1000天11.12和11.86。VP和LP分流的平均感染率为每次手术的6%和5.2%，分别。引起CSF改道导管相关性感染（CDRI）的最常见病原体是肺炎克雷伯菌（n=14，40％）。通过cox回归分析，与感染风险增加独立相关的危险因素是引流管插入≥7天[HR：11.73，p-0.03]，EVD后路插入（枕骨）[HR：9.53，p-0.01]，术前ASA评分>3[HR：8.28，p-0.013]存在EVD/LD泄漏[HR：17.24，p<0.0001]，男性[HR：2.05，p-0.05]和相关的围手术期头皮感染的存在[HR：3.531，p-0.005]。发现转向窄谱手术预防性抗生素[系数：-1.284，p-0.03]和CSF采样频率降低[系数：-1.741，p-0.02]与CDRI呈负相关。
结论：研究表明引流管插入≥7天，EVD后路插入,存在EVD/LD泄漏，男性和围手术期头皮皮肤和软组织感染的存在与感染风险增加相关.
