{"title":"螺栓连接的镀银心室外引流管与隧道式抗生素浸渍导管相比,感染风险较低:一项初步研究。","authors":"Raquel Gutiérrez-González, Teresa Mediavilla, Celia Ortega-Angulo, Teresa Kalantari, Alvaro Zamarron","doi":"10.1016/j.jhin.2025.08.014","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>To compare the risk of ventriculostomy-related infection (VRI) according to the type of external ventricular drain (EVD) used: bolt-connected silver-coated EVD (antimicrobial effect) vs. tunnelled antibiotic-impregnated EVD, and determine which catheter is superior. The secondary endpoint is to estimate the infection risk depending on the ventriculostomy duration.</p><p><strong>Methods: </strong>Prospective single-centre cohort study. All patients who underwent EVD placement between January 2022 and August 2024 were included. Infection was the primary endpoint. Cox regression analysis was used to determine the hazard ratio (HR) depending on the type of catheter, adjusting for possible confounding covariables. Kaplan-Meier curves were used to estimate the cumulative risk of infection.</p><p><strong>Results: </strong>90 procedures were analysed. The overall infection rate was 7.8%. A significantly higher infection risk was confirmed when tunnelled antibiotic-impregnated catheters were used compared to bolt-connected silver-coated drains after adjusting by the setting of the placement and duration of ventriculostomy (HR 7.61 [95% CI 1.30-44.38, p=0.024]). Placement of the device in the ICU was also independently associated with a higher risk of infection than in the operating room (HR 8.16 [95% CI 1.17-56.94, p=0.034]). The risk of VRI was 0% by day five, 1.6% by day 10, and 23.5% by day 30.</p><p><strong>Conclusions: </strong>Bolt-connected silver-coated catheters (antimicrobial coating and skull anchoring) were associated with an 88% lower risk of VRI than subcutaneous tunnelled antibiotic-impregnated catheters. Drain placement in the ICU was also associated with a higher risk of infection. The risk of VRI was 0% by day five and 1.6% by day 10.</p>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":" ","pages":""},"PeriodicalIF":3.1000,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Bolt-connected silver-coated external ventricular drains have a lower risk of infection compared with tunnelled antibiotic-impregnated catheters: a pilot study.\",\"authors\":\"Raquel Gutiérrez-González, Teresa Mediavilla, Celia Ortega-Angulo, Teresa Kalantari, Alvaro Zamarron\",\"doi\":\"10.1016/j.jhin.2025.08.014\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>To compare the risk of ventriculostomy-related infection (VRI) according to the type of external ventricular drain (EVD) used: bolt-connected silver-coated EVD (antimicrobial effect) vs. tunnelled antibiotic-impregnated EVD, and determine which catheter is superior. The secondary endpoint is to estimate the infection risk depending on the ventriculostomy duration.</p><p><strong>Methods: </strong>Prospective single-centre cohort study. All patients who underwent EVD placement between January 2022 and August 2024 were included. Infection was the primary endpoint. Cox regression analysis was used to determine the hazard ratio (HR) depending on the type of catheter, adjusting for possible confounding covariables. Kaplan-Meier curves were used to estimate the cumulative risk of infection.</p><p><strong>Results: </strong>90 procedures were analysed. The overall infection rate was 7.8%. A significantly higher infection risk was confirmed when tunnelled antibiotic-impregnated catheters were used compared to bolt-connected silver-coated drains after adjusting by the setting of the placement and duration of ventriculostomy (HR 7.61 [95% CI 1.30-44.38, p=0.024]). Placement of the device in the ICU was also independently associated with a higher risk of infection than in the operating room (HR 8.16 [95% CI 1.17-56.94, p=0.034]). The risk of VRI was 0% by day five, 1.6% by day 10, and 23.5% by day 30.</p><p><strong>Conclusions: </strong>Bolt-connected silver-coated catheters (antimicrobial coating and skull anchoring) were associated with an 88% lower risk of VRI than subcutaneous tunnelled antibiotic-impregnated catheters. Drain placement in the ICU was also associated with a higher risk of infection. The risk of VRI was 0% by day five and 1.6% by day 10.</p>\",\"PeriodicalId\":54806,\"journal\":{\"name\":\"Journal of Hospital Infection\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.1000,\"publicationDate\":\"2025-09-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Hospital Infection\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.jhin.2025.08.014\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Hospital Infection","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jhin.2025.08.014","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
引用次数: 0
摘要
目的:根据使用的脑室外引流管(EVD)的类型,比较脑室造瘘相关感染(VRI)的风险:螺栓连接的镀银EVD(抗菌效果)与隧道式抗生素浸渍EVD,并确定哪种导管更优。次要终点是估计感染风险取决于脑室造口术的持续时间。方法:前瞻性单中心队列研究。所有在2022年1月至2024年8月期间接受EVD植入的患者都被纳入研究。感染是主要终点。采用Cox回归分析确定不同导管类型的风险比(HR),并对可能的混杂协变量进行调整。Kaplan-Meier曲线用于估计感染的累积风险。结果:对90例手术进行了分析。总感染率为7.8%。经脑室造口的位置设置和持续时间调整后,与螺栓连接的镀银引流管相比,使用隧道式抗生素浸渍导管的感染风险明显更高(HR 7.61 [95% CI 1.30-44.38, p=0.024])。设备放置在ICU也与感染风险高于手术室独立相关(HR 8.16 [95% CI 1.17-56.94, p=0.034])。第5天VRI风险为0%,第10天为1.6%,第30天为23.5%。结论:螺栓连接银涂层导管(抗菌涂层和颅骨锚定)与皮下隧道抗生素浸渍导管相比,VRI风险降低88%。在ICU放置引流管也与较高的感染风险相关。第5天VRI的风险为0%,第10天为1.6%。
Bolt-connected silver-coated external ventricular drains have a lower risk of infection compared with tunnelled antibiotic-impregnated catheters: a pilot study.
Purpose: To compare the risk of ventriculostomy-related infection (VRI) according to the type of external ventricular drain (EVD) used: bolt-connected silver-coated EVD (antimicrobial effect) vs. tunnelled antibiotic-impregnated EVD, and determine which catheter is superior. The secondary endpoint is to estimate the infection risk depending on the ventriculostomy duration.
Methods: Prospective single-centre cohort study. All patients who underwent EVD placement between January 2022 and August 2024 were included. Infection was the primary endpoint. Cox regression analysis was used to determine the hazard ratio (HR) depending on the type of catheter, adjusting for possible confounding covariables. Kaplan-Meier curves were used to estimate the cumulative risk of infection.
Results: 90 procedures were analysed. The overall infection rate was 7.8%. A significantly higher infection risk was confirmed when tunnelled antibiotic-impregnated catheters were used compared to bolt-connected silver-coated drains after adjusting by the setting of the placement and duration of ventriculostomy (HR 7.61 [95% CI 1.30-44.38, p=0.024]). Placement of the device in the ICU was also independently associated with a higher risk of infection than in the operating room (HR 8.16 [95% CI 1.17-56.94, p=0.034]). The risk of VRI was 0% by day five, 1.6% by day 10, and 23.5% by day 30.
Conclusions: Bolt-connected silver-coated catheters (antimicrobial coating and skull anchoring) were associated with an 88% lower risk of VRI than subcutaneous tunnelled antibiotic-impregnated catheters. Drain placement in the ICU was also associated with a higher risk of infection. The risk of VRI was 0% by day five and 1.6% by day 10.
期刊介绍:
The Journal of Hospital Infection is the editorially independent scientific publication of the Healthcare Infection Society. The aim of the Journal is to publish high quality research and information relating to infection prevention and control that is relevant to an international audience.
The Journal welcomes submissions that relate to all aspects of infection prevention and control in healthcare settings. This includes submissions that:
provide new insight into the epidemiology, surveillance, or prevention and control of healthcare-associated infections and antimicrobial resistance in healthcare settings;
provide new insight into cleaning, disinfection and decontamination;
provide new insight into the design of healthcare premises;
describe novel aspects of outbreaks of infection;
throw light on techniques for effective antimicrobial stewardship;
describe novel techniques (laboratory-based or point of care) for the detection of infection or antimicrobial resistance in the healthcare setting, particularly if these can be used to facilitate infection prevention and control;
improve understanding of the motivations of safe healthcare behaviour, or describe techniques for achieving behavioural and cultural change;
improve understanding of the use of IT systems in infection surveillance and prevention and control.