Ventriculostomy-associated infection rates and routine EVD replacement: a systematic review and meta-analysis.

IF 0.8 4区医学 Q4 CLINICAL NEUROLOGY

British Journal of Neurosurgery Pub Date : 2026-10-15 DOI:10.1080/02688697.2026.2743512

Saleh Salah Safi, Menatalla Metwally Ramadan Said Elbadway, Mariah Mancha, Ibtihal Abdelgadir, Ian Pople, Khalid Al-Kharazi

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引用次数: 0

Abstract

Background: External ventricular drainage (EVD) is associated with a significant risk of ventriculostomy-associated infection (VAI), which can lead to severe complications. The relationship between catheterization duration, routine catheter exchange, and infection risk remains debated. This meta-analysis aimed to estimate the contemporary pooled VAI rate and evaluate the effect of catheter type and management strategy on infection risk.

Methods: PROSPERO-registered (CRD42025632997) systematic review and meta-analysis. MEDLINE, Cochrane, Embase, Scopus, and CINAHL were searched through February 2024. Studies reporting EVD infection counts with catheter-days were included. Random-effects (DerSimonian-Laird) meta-analysis pooled log-transformed infection rates. Subgroup analyses compared impregnated versus plain catheters and pre-/post-2010 era. Two RCTs were qualitatively synthesized. Risk of bias was assessed using the Newcastle-Ottawa Scale and Cochrane RoB2.

Results: Nineteen cohort studies and two RCTs were included. Critically, neither RCT demonstrated benefit from routine replacement (Wong 2002: RR = 1.80, 95% CI 0.33-9.81, p = 0.50; Keong 2012: RR = 0.58, 95% CI 0.33-0.99, favouring silver-impregnated catheters over standard catheters rather than supporting exchange). All 19 observational cohort studies confirmed that routine fixed-interval EVD replacement was not practiced at any included institution, precluding direct observational comparison. Eight cohort studies contributed 167 infections across 22,839 catheter-days to quantitative synthesis. The pooled VAI rate was 7.87 per 1,000 catheter-days (95% CI 4.67-13.25; I²=91%, τ²=0.506). The 95% prediction interval was 1.78-34.85/1,000 catheter-days, reflecting wide variation across settings. Antimicrobial-impregnated catheters had a pooled rate of 4.85 versus 17.03/1,000 catheter-days for plain catheters.

Conclusion: Routine fixed-interval EVD replacement is not supported by current evidence, independently confirming IDSA 2017 Recommendation 78. Antimicrobial-impregnated catheters and infection prevention bundles appear more effective at reducing VAI rates than scheduled catheter exchange alone. Further adequately powered RCTs are needed and research should standardize reporting of institutional replacement practices and evaluate broader-spectrum antimicrobial catheter technologies targeting both gram-positive and gram-negative organisms.

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脑室造口术相关感染率和常规EVD替换：系统回顾和荟萃分析

背景：脑室外引流（EVD）与脑室造口相关感染（VAI）的显著风险相关，后者可导致严重的并发症。导尿时间、常规导管更换和感染风险之间的关系仍存在争议。本荟萃分析旨在估计当代合并VAI率，并评估导管类型和管理策略对感染风险的影响。方法：prospero注册（CRD42025632997）系统评价和meta分析。MEDLINE、Cochrane、Embase、Scopus和CINAHL的检索截止到2024年2月。报告以导管天数计算的EVD感染计数的研究被纳入。随机效应（dersimonan - laird）荟萃分析汇集了对数转化的感染率。亚组分析比较了浸渍导管与普通导管以及2010年前后的情况。定性合成两项随机对照试验。偏倚风险采用纽卡斯尔-渥太华量表和Cochrane RoB2进行评估。结果：纳入19项队列研究和2项随机对照试验。关键的是，两项随机对照试验都没有显示常规替换的益处（Wong 2002: RR = 1.80, 95% CI 0.33-9.81, p = 0.50; Keong 2012: RR = 0.58, 95% CI 0.33-0.99，与标准导管相比，银浸渍导管更受青睐，而不是支持交换）。所有19项观察性队列研究均证实，在任何纳入的机构中均未实施常规固定间隔EVD置换，因此排除了直接观察性比较。8项队列研究在22,839个导管日中贡献了167例感染。合并VAI率为7.87 / 1,000导管天（95% CI 4.67 ~ 13.25; I2=91%, τ2=0.506）。95%的预测区间为1.78-34.85/ 1000导管天，反映了不同设置的差异很大。抗菌浸透导管的合并率为4.85，而普通导管的合并率为17.03/ 1000导管天。结论：目前的证据不支持常规固定间隔EVD置换，独立证实了IDSA 2017建议78。抗菌浸渍导管和感染预防束在降低VAI率方面似乎比单独安排导管交换更有效。需要进一步的有充分动力的随机对照试验，研究应使机构替代做法的报告标准化，并评估针对革兰氏阳性和革兰氏阴性菌的广谱抗菌导管技术。

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来源期刊

British Journal of Neurosurgery 医学-临床神经学

CiteScore

2.30

自引率

9.10%

发文量

139

审稿时长

3-8 weeks

期刊介绍： The British Journal of Neurosurgery is a leading international forum for debate in the field of neurosurgery, publishing original peer-reviewed articles of the highest quality, along with comment and correspondence on all topics of current interest to neurosurgeons worldwide. Coverage includes all aspects of case assessment and surgical practice, as well as wide-ranging research, with an emphasis on clinical rather than experimental material. Special emphasis is placed on postgraduate education with review articles on basic neurosciences and on the theory behind advances in techniques, investigation and clinical management. All papers are submitted to rigorous and independent peer-review, ensuring the journal’s wide citation and its appearance in the major abstracting and indexing services.