Infecção liquórica em drenagem ventricular externa: avaliação dos fatores de risco em 110 pacientes de uma única instituição^[*]

Abstract

Objectives External ventricular drainage (EVD) is extensively used in the neurosurgical practice with the purpose of monitoring the intracranial pressure and draining the cerebrospinal fluid (CSF). Despite its remarkable benefits, the technique is not devoid of risks, notably infections, which have been reported in up to 45% of the cases.

Methods A retrospective analysis of the main risk factors for CSF infection in neurosurgical patients submitted to EVD at a single institution. We recorded and submitted to statistical comparison every risk factor for CSF infection present or absent in each of the 110 EVD patients enrolled, 53 males and 57 females, with an average age of 52.9 years, with different underlying neurosurgical conditions.

Results Infection of the CSF occurred in 32 patients (29%). The rate of mortality related to CSF infection was of 18.7% (6 of 32). The risk factors that showed statistical significance for CSF infection in this series were: emergency surgery; length of stay at the intensive care unit (UCI); duration of the EVD; parenchymal and/or intraventricular hemorrhage; simultaneous infections; time of bladder catheterization; and the use of non-disposable adhesive drapes as part of the preparation of the wound area.

Conclusions Infection of the CSF in patients submitted to EVD is multifactorial and a challenge in terms of prevention. Further studies proposing scores with blended risk factors may be useful to prevent and reduce the morbidity and mortality associated with CSF infection.

Resumo

Objetivos A derivação ventricular externa (DVE) é frequentemente utilizada na prática neurocirúrgica para monitorização da pressão intracraniana e drenagem de líquido cefalorraquidiano (LCR). Apesar dos evidentes benefícios, a utilização do método não é isenta de riscos, notadamente infecção, podendo atingir incidência de até 45%.

Métodos Realizamos análise retrospectiva dos principais fatores de risco para infecção do LCR em pacientes neurocirúrgicos com DVE em uma única instituição. Registramos e analisamos, através de comparações estatísticas, todos os fatores de risco para infecção do LCR presentes ou ausentes em uma série de 110 pacientes submetidos à DVE, onde 53 eram homens e 57 mulheres, com idade média de 52,9 anos.

Resultados Infecção do LCR ocorreu em 32 pacientes (29%). A taxa de mortalidade relacionada diretamente à infecção liquórica foi de 18,7% (6 de 32). Os fatores de risco que se mostraram significantes para infecção do LCR nesta série foram: cirurgia de emergência, tempo de permanência em UTI, tempo de permanência da DVE, hemorragia parenquimatosa e/ou intraventricular, foco infeccioso distante concomitante, uso prolongado de sonda vesical e o uso de campos cirúrgicos não adesivos durante a confecção da DVE.

Conclusões A infecção do LCR em pacientes com DVE é multifatorial e um desafio para sua prevenção. Estudos adicionais, com propostas de escores que combinem vários fatores de risco podem ser úteis na prevenção e redução dos índices de infecção liquórica com repercussão positiva sobre morbidade e mortalidade associadas.

Keywords

external ventricular drainage - cerebrospinal fluid infection - risk factors

Palavras-chave

derivação ventricular externa - infecção liquórica - fatores de risco

^* Work developed at the Neurosurgery Service of Hospital de Clínicas, Universidade Federal do Paraná (UFPR), Curitiba, Paraná, Brazil.

Publication History

Received: 19 February 2020

Accepted: 12 May 2020

Article published online:
31 July 2020

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