title: External ventricular drain infections are independent of drain duration: an argument against elective revision.
abstract: OBJECTIVE
  The authors explored the relationship among the duration of external ventricular drainage, revision of external ventricular drains (EVDs), and cerebrospinal fluid (CSF) infection to shed light on the practice of electively revising these drains.
  
  
  METHODS
  In a retrospective study of 199 patients with 269 EVDs in the intensive care unit at a major trauma center in Australasia, the authors found 21 CSF infections. Acinetobacter accounted for 10 (48%) of these infections. Whereas the duration of drainage was not an independent predictor of infection, multiple insertions of EVDs was a significant risk factor. Second and third EVDs in previously uninfected patients were more likely to become infected than first EVDs. An EVD infection was initially identified a mean of 5.5 +/- 0.7 days postinsertion (standard error of the mean); these data--that is, the number of days--were normally distributed.
  
  
  CONCLUSIONS
  This pattern of infection is best explained by EVD-associated CSF infections being acquired by the introduction of bacteria on insertion of the drain rather than by subsequent retrograde colonization. Elective EVD revision would be expected to increase infection rates in light of these results, and thus the practice has been abandoned by the authors' institution.
authors: Department of Neurosurgery, The Alfred Hospital, Melbourne, Victoria, Australia.
authors: Cheng H
authors: CH
authors: Lo
authors: Denis
authors: D
authors: Spelman
authors: Michael
authors: M
authors: Bailey
authors: D James
authors: DJ
authors: Cooper
authors: Jeffrey V
authors: JV
authors: Rosenfeld
authors: John E
authors: JE
authors: Brecknell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002408:Catheters, Indwelling / Q000009:adverse effects*; D020806:Central Nervous System Bacterial Infections / Q000209:etiology* / Q000601:surgery*; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects* / Q000295:instrumentation*; D003428:Cross Infection / Q000209:etiology / Q000601:surgery; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors