Avaliação retrospectiva dos fatores de risco para infecção e mortalidade em derivações ventriculares externas

Abstract

Background: External ventricular drain (EVD) is a very useful tool in neurosurgery. Installation technique is simple, it is affordable by most of health systems, being one of the main treatments for acute idrocephalus. The main complication related to its use is cerebrospinal fluid (CSF) infection. The preventive value of antibiotic use is not well defined. This study aims to define the main risk factors for infection and mortality in EVD implanted in a public tertiary hospital in Belo Horizonte.Methods: A retrospective review of 137 cases of EVD implants were done, from January 2006 to December 2008, 107 patients included. Twenty five patients were re-operated, with a total of 141 shunts implanted.Results: Forty-eight (45%) patients were male and 59 (55%) female. The age ranged from 6 to 86 years old (52,12 ± 15,51 years). Incidence of EVD-related infection was 32,7%. Device permanence varied from 2 to 54 days (mean of 10 days). EVDs that have stayed more than 9,5days, and device changes were statistically significant factors for CSF infection. Antibiotic prophylaxis did not change the infection rate (p = 0,395). Eighty patients died (74,7 %), and the factors related to death were the hydrocephalus cause (p=0,008), intraventricular bleeding(p=0,016) and associated diseases (p=0,016). Conclusions: Risk factors for EVD infection were length of stay superior to 9,5 days anddevice changes. There is no advantage for antibiotic prophylaxis regarding CSF infection with EVD implants. The mortality was related to the hydrocephalus cause, intraventricular bleeding and associated diseases.