gms | German Medical Science

Objective: Patients suffering from intracranial hemorrhage frequently require external ventricular drainage for the treatment of acute hydrocephalus. This patient group is at a particular risk for cerebrospinal fluid (csf) infection. According to the literature, one reason for the high incidence of csf infection in these patients is the deposition of blood components on the surface of the drain, creating a permissive environment for bacterial growth. We therefore hypothesized, that a regular change of the external ventricular drainage (EVD) might be able to lower the infection rate in patients with intracranial hemorrhage. We performed a prospective, randomised clinical study to assess the influence of a regular EVD – change on the incidence of drainage – related csf infection.

Methods: Patients requiring EVD treatment due to intracranial hemorrhage were randomly assigned to the treatment groups (changing or non-changing group) based on the date of admission. In the changing group EVD was changed every seventh day. The non-changing group received no regular EVD change. The definition of EVD-related infection was based on clinical signs (fever, impaired neurological performance, pathological change of csf parameters) and a positive microbiological culture.

Results: We included 50 patients per treatment group. Most of the patients needed EVD treatment because subarachnoid hemorrhage (SAH) without (42 patients) and with (15 patients) intraventricular hemorrhage. The remaining patients had intracerebral hemorrhage without (16 patients) or with (27 patients) intraventricular bleeding. The mean age of our patients was 53,3 years. There was no significant difference between the two treatment groups concerning age, gender distribution or accompanying diseases. Mean duration for the EVD treatment was 10,5 days in the changing group, with a mean changing rate of 1 change per patient. In the non-changing group the mean duration for EVD was 10,9 days. The infection rate in the changing group was 18% and clearly higher than in the non-changing group, where we found an infection rate of 8%, although this difference was not statistically significant (p=0,23).

Conclusions: Our data show, that regular changes of external ventricular drainage in patients with intracranial hemorrhage cannot lower infection rates. On the contrary, we observed higher infection rates when EVD was changed on a regular basis in these patients.