Florian Ebel, Emilia Westarp, Matteo Poretti, Matthias von Rotz, Simon Stohler, Raymond Chen, Raphael Guzman, Maja Weisser, Sarah Tschudin-Sutter, Luigi Mariani, Michel Roethlisberger
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Univariable and multivariable logistic regression analyses were used to assess the association between the Barrow Neurological Institute (BNI) grading scale for subarachnoid hemorrhage and the intraventricular hemorrhage (IVH) score for extent and anatomical distribution of intracerebral bleeding with EVDAI risk. Cox regression analysis was employed to investigate the relationship between hemorrhage extent and the timing of EVDAI onset.</p><p><strong>Results: </strong>One hundred and ninety-four patients with aSAH received 228 EVDs with a total of cumulative 2,258 EVD days. Overall EVDAI rates were 14% (27/194) per patient and 12% (27/228) per EVD. EVDAI was associated with a larger subarachnoid blood clot (BNI grade 4; odds ratio 6.66, 95% confidence interval 2.04-21.68; p = 0.002) and higher IVH scores (odds ratio 1.33, 95% confidence interval 1.05-1.69; p = 0.02). Intracerebral hemorrhage was more frequently localized in the posterior fossa in the EVDAI group (20% vs. 0%, p = 0.004). Multivariable analysis confirmed a positive independent correlation with larger blood clots. Cox regression demonstrated earlier EVDAI onset in association with higher BNI grades and IVH scores.</p><p><strong>Conclusions: </strong>Both the quantity and radiological distribution of subarachnoid and ventricular blood positively correlate with EVD-associated nosocomial meningitis, eventually accelerating an earlier infection onset. These findings should help guide future research on EVDAI prevention in patients with aSAH.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6000,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Impact of Hemorrhage Extent on External Ventricular Drain-Associated Infections in Aneurysmal Subarachnoid Hemorrhage.\",\"authors\":\"Florian Ebel, Emilia Westarp, Matteo Poretti, Matthias von Rotz, Simon Stohler, Raymond Chen, Raphael Guzman, Maja Weisser, Sarah Tschudin-Sutter, Luigi Mariani, Michel Roethlisberger\",\"doi\":\"10.1007/s12028-025-02310-4\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>External ventricular drain (EVD)-associated infections (EVDAI) remain a relevant complication of acute hydrocephalus treatment following aneurysmal subarachnoid hemorrhage (aSAH). 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EVDAI was associated with a larger subarachnoid blood clot (BNI grade 4; odds ratio 6.66, 95% confidence interval 2.04-21.68; p = 0.002) and higher IVH scores (odds ratio 1.33, 95% confidence interval 1.05-1.69; p = 0.02). Intracerebral hemorrhage was more frequently localized in the posterior fossa in the EVDAI group (20% vs. 0%, p = 0.004). Multivariable analysis confirmed a positive independent correlation with larger blood clots. Cox regression demonstrated earlier EVDAI onset in association with higher BNI grades and IVH scores.</p><p><strong>Conclusions: </strong>Both the quantity and radiological distribution of subarachnoid and ventricular blood positively correlate with EVD-associated nosocomial meningitis, eventually accelerating an earlier infection onset. 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引用次数: 0
摘要
背景：脑室外漏（EVD）相关感染（EVDAI）仍然是动脉瘤性蛛网膜下腔出血（aSAH）后急性脑积水治疗的相关并发症。蛛网膜下腔血和脑室血的放射量和解剖分布是否影响EVDAI的发生率尚未得到深入的研究。方法：回顾性分析2009-2023年急诊脑室造口术的aSAH患者。采用单变量和多变量logistic回归分析评估Barrow神经学研究所（BNI）蛛网膜下腔出血分级量表与脑室内出血（IVH）评分与EVDAI风险的脑出血程度和解剖分布之间的相关性。采用Cox回归分析探讨出血程度与EVDAI发病时间的关系。结果：194例aSAH患者接受了228例EVD，累计EVD天数为2258天。EVDAI的总发生率为每位患者14% (27/194)，EVD为12%（27/228）。EVDAI与较大的蛛网膜下腔血凝块相关(BNI 4级；优势比6.66,95%可信区间2.04 ~ 21.68；p = 0.002)和更高的IVH评分(优势比1.33,95%可信区间1.05-1.69；p = 0.02)。EVDAI组脑出血多发于后窝（20% vs. 0%, p = 0.004）。多变量分析证实与较大的血凝块呈正相关。Cox回归显示，早期EVDAI发病与较高的BNI分级和IVH评分相关。结论：蛛网膜下腔血和脑室血的数量和放射学分布与evd相关的院内脑膜炎呈正相关，最终加速早期感染的发生。这些发现有助于指导未来aSAH患者EVDAI预防的研究。
Impact of Hemorrhage Extent on External Ventricular Drain-Associated Infections in Aneurysmal Subarachnoid Hemorrhage.
Background: External ventricular drain (EVD)-associated infections (EVDAI) remain a relevant complication of acute hydrocephalus treatment following aneurysmal subarachnoid hemorrhage (aSAH). Whether radiological quantity and anatomical distribution of subarachnoid and ventricular blood impact EVDAI rates has not been thoroughly studied to date.
Methods: This was a retrospective (2009-2023) analysis of patients with aSAH undergoing emergency ventriculostomy. Univariable and multivariable logistic regression analyses were used to assess the association between the Barrow Neurological Institute (BNI) grading scale for subarachnoid hemorrhage and the intraventricular hemorrhage (IVH) score for extent and anatomical distribution of intracerebral bleeding with EVDAI risk. Cox regression analysis was employed to investigate the relationship between hemorrhage extent and the timing of EVDAI onset.
Results: One hundred and ninety-four patients with aSAH received 228 EVDs with a total of cumulative 2,258 EVD days. Overall EVDAI rates were 14% (27/194) per patient and 12% (27/228) per EVD. EVDAI was associated with a larger subarachnoid blood clot (BNI grade 4; odds ratio 6.66, 95% confidence interval 2.04-21.68; p = 0.002) and higher IVH scores (odds ratio 1.33, 95% confidence interval 1.05-1.69; p = 0.02). Intracerebral hemorrhage was more frequently localized in the posterior fossa in the EVDAI group (20% vs. 0%, p = 0.004). Multivariable analysis confirmed a positive independent correlation with larger blood clots. Cox regression demonstrated earlier EVDAI onset in association with higher BNI grades and IVH scores.
Conclusions: Both the quantity and radiological distribution of subarachnoid and ventricular blood positively correlate with EVD-associated nosocomial meningitis, eventually accelerating an earlier infection onset. These findings should help guide future research on EVDAI prevention in patients with aSAH.
期刊介绍：
Neurocritical Care is a peer reviewed scientific publication whose major goal is to disseminate new knowledge on all aspects of acute neurological care. It is directed towards neurosurgeons, neuro-intensivists, neurologists, anesthesiologists, emergency physicians, and critical care nurses treating patients with urgent neurologic disorders. These are conditions that may potentially evolve rapidly and could need immediate medical or surgical intervention. Neurocritical Care provides a comprehensive overview of current developments in intensive care neurology, neurosurgery and neuroanesthesia and includes information about new therapeutic avenues and technological innovations. Neurocritical Care is the official journal of the Neurocritical Care Society.
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