Development of an Evidence-based Care Bundle for Prevention of External Ventricular Drain-related Infection: Results of a Single-center Prospective Cohort Study and Literature Review.
Dinoop K Ponnambath, Ganesh Divakar, Jincy Mamachan, Shiny Biju, Kavita Raja, Mathew Abraham
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Abstract
Background: External ventricular drain (EVD)-related infection (ERI) is a common complication in cranial neurosurgery practice with high mortality. The risk factors associated with ERI are not well studied in low- and middle-income countries (LMIC) like India. Identifying the risk variables is a necessity to design robust evidence-based care bundles for ERI prevention.
Materials and methods: This is a single-center prospective cohort study. Patients with and without ERI during the 2-year study period were analyzed along with literature review to identify the risk variables associated with ERI. The Institute for Healthcare Improvement (IHI) comprehensive flowchart was used to develop the concept care bundle for ERI prevention.
Results: A total of 211 EVD were inserted during the study period. 15 ERI (7.1%) were identified based on IDSA criteria, with an average infection rate of 11.12 per 1000 EVD days. Gram negative bacteria (GNB) were the predominant pathogen (12/15, 80%), with Klebsiella pneumoniae (6/15, 40%) being the most common bacteria isolated. In multivariate analysis, the risk variables associated with ERI were use of broad spectrum pre-surgical antimicrobial prophylaxis for long duration, choice of posterior craniometric points for EVD insertion, EVD duration >7 days, EVD leak and surveillance cerebrospinal fluid (CSF) sampling at periodic intervals. Based on the risk variables identified in this study and literature review, a consensus decision on the care elements for the insertion and maintenance phases was chosen for the concept care bundle for ERI prevention.
Conclusion: An evidence-based concept care bundle for ERI prevention is proposed for further multicentric evaluation and validation.
How to cite this article: Ponnambath DK, Divakar G, Mamachan J, Biju S, Raja K, Abraham M. Development of an Evidence-based Care Bundle for Prevention of External Ventricular Drain-related Infection: Results of a Single-center Prospective Cohort Study and Literature Review. Indian J Crit Care Med 2024;28(8):760-768.
背景：脑室外引流管（EVD）相关感染（ERI）是颅神经外科手术中常见的并发症，死亡率很高。在印度等中低收入国家，与 EVD 相关的风险因素尚未得到充分研究。确定风险变量是设计预防ERI的循证护理捆绑方案的必要条件：这是一项单中心前瞻性队列研究。研究人员对两年研究期间患有和未患有 ERI 的患者进行了分析，并查阅了相关文献，以确定与 ERI 相关的风险变量。采用美国医疗保健改进研究所（IHI）的综合流程图来制定预防 ERI 的概念护理包：结果：研究期间共插入了 211 个 EVD。根据 IDSA 标准确定了 15 例 ERI（7.1%），平均感染率为每 1000 个 EVD 日 11.12 例。革兰氏阴性菌（GNB）是主要病原体（12/15，80%），肺炎克雷伯菌（6/15，40%）是最常见的分离细菌。在多变量分析中，与 ERI 相关的风险变量包括：术前长期使用广谱抗菌药物预防、选择后颅测量点插入 EVD、EVD 持续时间大于 7 天、EVD 泄漏和定期监测脑脊液（CSF）采样。根据本研究和文献综述中确定的风险变量，就插入和维持阶段的护理要素达成共识，并将其选定为预防 ERI 的概念护理包：结论：提出了预防 ERI 的循证概念护理包，供进一步的多中心评估和验证：Ponnambath DK, Divakar G, Mamachan J, Biju S, Raja K, Abraham M. Development of an Evidence-based Care Bundle for Prevention of External Ventricular Drain-related Infection：单中心前瞻性队列研究结果与文献综述》。Indian J Crit Care Med 2024;28(8):760-768.
期刊介绍：
Indian Journal of Critical Care Medicine (ISSN 0972-5229) is specialty periodical published under the auspices of Indian Society of Critical Care Medicine. Journal encourages research, education and dissemination of knowledge in the fields of critical and emergency medicine.
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