Retrospective analysis of complications and treatment after external ventricular drainage

Introduction:

The placement of an external ventricular drain (EVD) is a common emergency procedure in neurosurgery, and infections during the duration of the drain are frequent.

Objectives:

The aim of this study was to determine the influence of the type of antibiotic prophylaxis on EVD infections. Additionally, other factors influencing infections and complications were considered.

Materials & methods:

In a retrospective analysis of 564 patients (267 with subarachnoid hemorrhage, 297 with intracerebral hemorrhage) who underwent external ventricular drainage at the University Hospital Dresden between 2009 and 2015, the impact of antibiotic prophylaxis on EVD infections was investigated.

Results:

Overall, 37% of the patients experienced at least one complication related to the EVD. The majority of patients had EVD obstruction (13.5%), followed by misplacement (9.2%) and cerebrospinal fluid infections (6.2%). Obstructions and infections were particularly observed in combination with other complications. Antibiotic prophylaxis during the duration of the drain did not result in a decreased infection rate. The infection rate significantly increased with the number of EVD replacements and side changes. An initial occipital placement of the EVD was also associated with a significantly higher infection rate.

Conclusion:

Considering the results and literature research, antibiotic prophylaxis is only preferable during the operative procedures compared to prophylaxis throughout the duration of the drain. Given the combination of complications such as obstruction and infection, special attention is required. Sterile techniques and caution are necessary not only during the operation but also in daily care, as skin flora can contribute to the spectrum of pathogens. Whenever possible, the EVD placement should be done frontally.

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