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Surveillance of external ventricular drainage-associated meningitis and ventriculitis in German intensive care units

Published online by Cambridge University Press:  10 January 2020

Peter Bischoff Open the ORCID record for Peter Bischoff [Opens in a new window] ,
Christin Schröder ,
Petra Gastmeier  and
Christine Geffers
Peter Bischoff*
Affiliation:
Institute of Hygiene and Environmental Health, Charité–Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
Christin Schröder
Affiliation:
Institute of Hygiene and Environmental Health, Charité–Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
Petra Gastmeier
Affiliation:
Institute of Hygiene and Environmental Health, Charité–Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
Christine Geffers
Affiliation:
Institute of Hygiene and Environmental Health, Charité–Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
*
Author for correspondence: Peter Bischoff, E-mail: peter.bischoff@charite.de
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Abstract

Objective:

In light of the infection risk associated with external ventricular drainage (EVD), we decided to establish the surveillance of EVD-associated meningitis/ventriculitis in German intensive care units (ICUs) in the framework of the German national nosocomial infection surveillance system (KISS). Here, we present the current reference data and subsequent risk-factor analysis for EVD-associated meningitis/ventriculitis rates.

Methods:

The surveillance method corresponds with the surveillance methods for device-associated infections recommended by the National Healthcare Safety Network (NHSN). All ICUs participating for at least 1 month from 2008 to 2016 in the module ICU-KISS were included in the reference dataset and the multivariate analysis.

Results:

Current reference data (2008–2016) are based on input from 157 ICUs. The mean EVD-associated meningitis/ventriculitis rate per 1,000 EVD days was 3.96, with little variation between neurosurgical, surgical, interdisciplinary (hospitals with >400 beds), and neurological ICUs. In total, 893 EVD-associated meningitis/ventriculitis cases and 225,351 EVD days were included in the risk-factor analysis. After multivariate analysis, 2 factors remained significant: (1) stay in an ICU labeled other than neurosurgical, surgical, interdisciplinary (>400 beds), and neurological as a protective factor and (2) EVD utilization rate above the 75th quantile as a risk factor for acquisition of EVD-associated meningitis/ventriculitis.

Conclusions:

EVD-associated meningitis and ventriculitis are frequent complications of care in intensive care patients at risk. A long hospital stay and/or the presence of the EVD puts the patient at high risk for pathogen acquisition with subsequent infection.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 4 , April 2020 , pp. 452 - 457
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved

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Footnotes

PREVIOUS PRESENTATION: Part of this work was presented at the 28th European Congress of Clinical Microbiology and Infectious Diseases on April 21, 2018, in Madrid, Spain.

References

Rosenthal, V, Maki, D, Mehta, Y, et al.International Nosocomial Infection Control Consortium (INICC) report, data summary of 43 countries for 2007–2012. Device-associated module. Am J Infect Control 2014;42:942–956.CrossRefGoogle ScholarPubMed
Schröder, C, Schwab, F, Behnke, M, et al.Epidemiology of healthcare-associated infections in Germany: Nearly 20 years of surveillance. Int J Med Mikro 2015;305:799–806.Google ScholarPubMed
Fagan, R, Edwards, J, Park, B, Fridkin, S, Magill, S.Incidence trends in pathogen-specific central-line–associated bloodstream infections in US intensive care units, 1990–2010. Infect Control Hosp Epidemiol 2013;34:893–899.CrossRefGoogle ScholarPubMed
Lyke, K, Obasanjo, O, Williams, M, O’Brien, M, Chotani, R, Perl, T.Ventriculitis complicating use of intraventricular catheters in adult neurosurgical patients. Clin Infect Dis 2001;33:2028–2033.CrossRefGoogle ScholarPubMed
Ramanan, M, Lipman, J, Shorr, A, Shankar, A.A meta-analysis of ventriculostomy-associated cerebrospinal fluid infections. BMC Infect Dis 2015;15:3.CrossRefGoogle ScholarPubMed
Gastmeier, P, Geffers, C, Brandt, C, et al.Effectiveness of a nationwide nosocomial infection surveillance system for reducing nosocomial infetions. J Hosp Infect 2006;64:16–22.CrossRefGoogle Scholar
Horan, T, Andrus, M, Dudeck, M.CDC/NHSN surveillance definition of healthcare-associated infection and criteria for specific types of infections in the acute-care setting. Am J Infect Control 2008;36:309–332.CrossRefGoogle ScholarPubMed
Schröder, C, Behnke, M, Gastmeier, P, Schwab, F, Geffers, C.Case vignettes to evaluate the accuracy of identifying healthcare-associated infections by surveillance persons. J Hosp Infect 2015;90:322–326.CrossRefGoogle ScholarPubMed
Reference data for neurosurgical intensive care untits. Krankenhaus Infektions Surveillance System. Nationales Referenzzentrum für für Surveillance von nosokomialen Infektionen website. http://www.nrz-hygiene.de/surveillance/kiss/its-kiss/infektionen/. Published 2017. Accessed June 26, 2018.Google Scholar
Arabi, Y, Memish, Z, Balkhy, H, et al.Ventriculostomy-associated infections: incidence and risk factors. Am J Infect Control 2005;33:137–143.CrossRefGoogle ScholarPubMed
Citerio, G, Signorini, L, Bronco, A, et al.External ventricular and lumbar drain device infections in ICU patients: a prospective multicenter Italian study. Crit Care Med 2015;43:1630–1637.CrossRefGoogle ScholarPubMed
Leverstein-van Hall, M, Hopmans, T, van der Sprenkel, J, et al.A bundle approach to reduce the incidence of external ventricular and lumbar drain-related infections. J Neurosurg 2010;112:345–353.CrossRefGoogle ScholarPubMed
Scheithauer, S, Schulze-Steinen, H, Hollig, A, et al.Significant reduction of external ventricular drainage-associated meningoventriculitis by chlorhexidine-containing dressings: a before–after trial. Clin Infect Dis 2016;62:404–405.CrossRefGoogle ScholarPubMed
Hagel, S, Bruns, T, Pletz, MW, Engel, C, Kalff, R, Ewald, C.External ventricular drain infections: risk factors and outcome. Interdiscip Perspect Infect Dis 2014;2014:708531.CrossRefGoogle ScholarPubMed
van Mourik, M, Troelstra, A, Berkelbach, van der Sprenkel J, et al.Validation of an automated surveillance approach for drain-related meningitis: a multicenter study. Infect Control Hosp Epidemiol 2015;36:65–75.CrossRefGoogle ScholarPubMed
Hoefnagel, D, Dammers, R, Ter Laak-Poort, MP, Avezaat, CJ.Risk factors for infections related to external ventricular drainage. Acta Neurochir (Wien) 2008;150:209–214.CrossRefGoogle ScholarPubMed
Jamjoom, AAB, Joannides, AJ, Poon, MT, et al.Prospective, multicentre study of external ventricular drainage-related infections in the UK and Ireland. J Neurol Neurosurg Psychiatry 2018;89:120–126.CrossRefGoogle ScholarPubMed
Martin, RM, Zimmermann, LL, Huynh, M, Polage, CR.Diagnostic approach to health care- and device-associated central nervous system infections. J Clin Microbiol 2018;56(11):pii: e00861-18. doi: 10.1128/JCM.00861-18.CrossRefGoogle ScholarPubMed
Lyke, KE, Obasanjo, OO, Williams, MA, O’Brien, M, Chotani, R, Perl, TM.Ventriculitis complicating use of intraventricular catheters in adult neurosurgical patients. Clin Infect Dis 2001;33:2028–2033.CrossRefGoogle ScholarPubMed
Alleyne, CH Jr., Hassan, M, Zabramski, JM.The efficacy and cost of prophylactic and perioprocedural antibiotics in patients with external ventricular drains. Neurosurgery 2000;47:1124–1127.CrossRefGoogle ScholarPubMed
Atkinson, R, Fikrey, L, Jones, A, Pringle, C, Patel, HC.Cerebrospinal fluid infection associated with silver-impregnated external ventricular drain catheters. World Neurosurg 2016;89:505–509.CrossRefGoogle ScholarPubMed
Bayston, R, Vera, L, Mills, A, Ashraf, W, Stevenson, O, Howdle, SM.In vitro antimicrobial activity of silver-processed catheters for neurosurgery. J Antimicrob Chemother 2010;65:258–265.CrossRefGoogle ScholarPubMed
Zuschneid, I, Schwab, F, Geffers, C, Rüden, H, Gastmeier, P.Reduction of central venous catheter-associated bloodstream infection through surveilance. Infect Control Hosp Epidemiol 2003;24:501–505.CrossRefGoogle Scholar
Zuschneid, I, Schwab, F, Geffers, C, Behnke, M, Rüden, H, Gastmeier, P.Trends in ventilator-associated pneumonia rates within the German nosocomial infection surveillance system (KISS). Infect Control Hosp Epidemiol 2007;28:314–318.CrossRefGoogle Scholar
Gastmeier, P, Behnke, M, Schwab, F, Geffers, C.Benchmarking of urinary tract infection rates: experiences from the intensive care unit component of the German national nosocomial infections surveillance system. J Hosp Infect 2011;78:41–44.CrossRefGoogle ScholarPubMed
Chatzi, M, Karvouniaris, M, Makris, D, et al.Bundle of measures for external cerebral ventricular drainage-associated ventriculitis. Crit Care Med 2014;2:66–73.CrossRefGoogle Scholar
Flint, A, Rao, V, Renda, N, Faigeles, B, Lasman, T, Sheridan, W.A simple protocol to prevent external ventricular drain infections. Neurosurgery 2013;72:993–999.CrossRefGoogle ScholarPubMed
Camacho, EF, Boszczowski, I, Freire, MP, et al.Impact of an educational intervention implanted in a neurological intensive care unit on rates of infection related to external ventricular drains. PLoS One 2013;8(2):e50708.CrossRefGoogle Scholar
Fried, HI, Nathan, BR, Rowe, AS, et al.The insertion and management of external ventricular drains: an evidence-based consensus statement. A statement for healthcare professionals from the Neurocritical Care Society. Neurocrit Care 2016;24:61–81.CrossRefGoogle ScholarPubMed
Clinical Guideline. External ventricular drains and intracranial pressure monitoring. The Royal Children’s Hospital Melbourne website. https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/External_Ventricular_Drains_and_Intracranial_Pressure_Monitoring/ Date of publication unlcear. Accessed November 27, 2019.Google Scholar
Greater Glasgow and Clyde Paediatric Guidelines website. http://www.clinicalguidelines.scot.nhs.uk/ggc-paediatric-guidelines/ggc-guidelines/intensive-and-critical-care/extra-ventricular-device-guideline-evd/. Published 2018. Accessed November 27, 2019.Google Scholar
Tunkel, AR, Hasbun, R, Bhimraj, A, et al. 2017 Infectious Diseases Society of America’s clinical practice guidelines for healthcare-associated ventriculitis and meningitis. Clin Infect Dis 2017;64(6):e34–e65.CrossRefGoogle ScholarPubMed