A meta-analysis of ventriculostomy-associated cerebrospinal fluid infections.
Citation: BMC Infectious Diseases. 15:3, 2015.PMID: 25567583Institution: MedStar Washington Hospital CenterDepartment: Medicine/Pulmonary-Critical CareForm of publication: Journal ArticleMedline article type(s): Journal Article | Meta-AnalysisSubject headings: *Catheters, Indwelling/ae [Adverse Effects] | *Central Nervous System Infections/ep [Epidemiology] | *Cerebrospinal Fluid/mi [Microbiology] | *Ventriculostomy/ae [Adverse Effects] | Central Nervous System Infections/et [Etiology] | Central Nervous System Infections/mi [Microbiology] | Humans | IncidenceYear: 2015Local holdings: Available online from MWHC library: 2001 - presentISSN:- 1471-2334
Item type | Current library | Collection | Call number | Status | Date due | Barcode |
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Journal Article | MedStar Authors Catalog | Article | 25567583 | Available | 25567583 |
Available online from MWHC library: 2001 - present
BACKGROUND: Ventriculostomy insertion is a common neurosurgical intervention and can be complicated by ventriculostomy-associated cerebrospinal fluid infection (VAI) which is associated with increased morbidity and mortality. This meta-analysis was aimed at determining the pooled incidence rate (number per 1000 catheter-days) of VAI.
CONCLUSIONS: The incidence rate of VAI is 11.4 per 1000 catheter-days. Further research should focus on analysis of risk factors for VAI and techniques for reducing the rate of VAI.
METHODS: Relevant studies were identified from MEDLINE and EMBASE and from reference searching of included studies and recent review articles on relevant topics. The Newcastle-Ottawa Scale was used to assess quality and risk of bias. A random effects model was used to pool individual study estimates and 95% confidence intervals (CI) were calculated using the exact Poisson method. Heterogeneity was assessed using the heterogeneity chi2 and I-squared tests. Subgroup analyses were performed and a funnel plot constructed to assess publication bias.
RESULTS: There were a total of 35 studies which yielded 752 infections from 66,706 catheter-days of observation. The overall pooled incidence rate of VAI was 11.4 per 1000 catheter days (95% CI 9.3 to 13.5), for high quality studies the rate was 10.6 (95% CI 8.3 to 13) and 13.5 (95% CI 8.9 to 18.1) for low quality studies. Studies which had mean duration of EVD treatment of less than 7 days had a pooled VAI rate of 19.6 per 1000 catheter-days, those with mean duration of 7-10 days had VAI rate of 12.8 per 1000 catheter-days and those with mean duration greater than 10 days had VAI rate of 8 per 1000 catheter-days. There was significant heterogeneity for the primary outcome (p = 0.004, I-squared = 44%) and most subgroups. The funnel plot did not show evidence for publication bias.
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