Investigation of risk factors for external ventricular drainage‑associated central nervous system infections in patients undergoing neurosurgery

Gatos,Charalampos; Fotakopoulos,George; Chatzi,Maria; Georgakopoulou,Vasiliki Epameinondas; Spandidos,Demetrios A.; Makris,Demosthenes; Fountas,Kostas N.

doi:10.3892/mi.2023.104

Investigation of risk factors for external ventricular drainage‑associated central nervous system infections in patients undergoing neurosurgery

Authors:
- Charalampos Gatos
- George Fotakopoulos
- Maria Chatzi
- Vasiliki Epameinondas Georgakopoulou
- Demetrios A. Spandidos
- Demosthenes Makris
- Kostas N. Fountas
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Affiliations: Department of Neurosurgery, General University Hospital of Larissa, 41221 Larissa, Greece, Department of Critical Care Medicine, General University Hospital of Larissa, 41221 Larissa, Greece, Department of Infectious Diseases and COVID‑19 Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece, Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
Published online on: August 29, 2023 https://doi.org/10.3892/mi.2023.104
Article Number: 44
Copyright : © Gatos et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].

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Abstract

Meningitis/ventriculitis (MV) is an illness which can occur as a complication following neurosurgical procedures. Devices such as an external ventricular drain (EVD) are also related to considerable complications, such as infections. The present study examined the risk factors associated with central nervous system (CNS) infections associated with the external ventricle drainage system. The present retrospective study included all patients hospitalized between April, 2011 and August, 2018 who had been receiving therapy with EVD for developed hydrocephalus. A total of 48 out of 65 patients were classified into two groups as follows: Patients without MV (group A) and patients who developed MV (group B). The durations of hospital stay and intensive care unit (ICU) stay were significantly lower in group A (32.4±24 and 21.1±11 days, respectively) compared to group B (54.7±37 and 42±24 days, respectively) (P=0.027 and P=0.001, respectively). The Acute Physiological and Chronic Health Evaluation II (APACHE II) score and EVD distance from the wound exit side to the burr hole were significantly lower in the survivors compared to the non‑survivors (17.5±6 and 15.4±4 vs. 22.5±6 and 39.8±38, respectively). Receiver operating characteristic analysis revealed that the APACHE II score with an area under the curve [(AUC) of 0.677, P=0.044, and 95% confidence interval (CI) of (0.516‑0.839)] and a cut‑off value of 14 could predict mortality with a sensitivity of 100% and a specificity of 71%; the EVD distance from the wound exit side from the burr hole with an AUC of 0.694 (P=0.028), 95% CI of 0.521‑0.866 and a cut‑off value of 11.5 mm could predict mortality with a sensitivity of 88% and a specificity of 83%. On the whole, the present study demonstrates that the EVD‑related distance from the wound exit side of the burr hole can predict poor outcomes due to CNS infections in patients undergoing neurosurgery.

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