Infectious complications related to external ventricular shunt. Incidence and risk factors
LUCÍA LÓPEZ-AMOR, LUCÍA VIÑA, LORENA MARTÍN, CLEMENTINA CALLEJA, RAQUEL RODRÍGUEZ-GARCÍA, IVÁN ASTOLA, LORENA FORCELLEDO, LAURA ÁLVAREZ-GARCÍA, CARMEN DÍAZ-GÓMEZ, JAVIER FERNÁNDEZ-DOMÍNGUEZ, FERNANDO VÁZQUEZ, DOLORES ESCUDERO, GRUPO DE INVESTIGACIÓN EN MICROBIOLOGÍA TRASLACIONAL DEL INSTITUTO DE INVESTIGACIÓN SANITARIA DEL PRINCIPADO DE ASTURIAS (ISPA)
Introduction. Infectious complications related to external ventricular shunt (ICREVS) are a main problem in neurocritical intensive care units (ICU). The aim of the review is to assess the incidence of ICREVS and to analyse factors involved. Material and methods. Retrospective analysis, adult polyvalent ICU in a third level reference hospital. Patients carrying external ventricular shunt (DVE) were included. Those patients with central nervous system infection diagnosed prior DVE placement were excluded. Results. 87 patients were included with 106 DVE. Most common admittance diagnosis was subarachnoid haemorrhage (49.4%). 31 patients with 32 DVE developed an ICREVS. Infection rate is 19.5 per 1000 days of shunt for ICREVS and 14 per 1000 days for ventriculitis. 31.6% of the patients developed ICREVS and 25.3% ventriculitis. Patients who developed ICREVS presented higher shunt manipulations (2.0 ± 0.6 vs. 3.26 ± 1.02, p=0.02), shunt repositioning (0.1 ± 0.1 vs. 0.2 ± 0.1) and ICU and hospital stay (29.8 ± 4.9 vs 49.8 ± 5.2, p<0.01 y 67.4 ± 18.8 vs. 108.9 ± 30.2, p=0.02. Those DVE with ICREVS were placed for longer not only at infection diagnosis but also at removal (12.6 ± 2.1 vs. 18.3 ± 3.6 and 12.6 ± 2.1 vs. 30.4 ± 7.3 days, p<0.01). No difference in mortality was found. Conclusions. One out of three patients with a DVE develops an infection. The risk factors are the number of manipulations, repositioning and the permanency days. Patients with ICREVS had a longer ICU and hospital average stay without an increase in mortality.
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