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Meta-Analysis
. 2015 Jan 8:15:3.
doi: 10.1186/s12879-014-0712-z.

A meta-analysis of ventriculostomy-associated cerebrospinal fluid infections

Mahesh Ramanan  1   2 , Jeffrey Lipman  3   4 , Andrew Shorr  5 , Aparna Shankar  6
Affiliations
Meta-Analysis

A meta-analysis of ventriculostomy-associated cerebrospinal fluid infections

Mahesh Ramanan et al. BMC Infect Dis. .

Abstract

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.

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 χ2 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.

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.

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Figures

Figure 1
Figure 1
Flow diagram of the search strategy and exclusions at each stage.
Figure 2
Figure 2
Forest plot of meta-analysis (random effects model) of ventriculostomy-associated infections. CI confidence interval.
Figure 3
Figure 3
Pie diagram of breakdown of 523 positive cerebrospinal fluid cultures.
Figure 4
Figure 4
Funnel plot of incidence of ventriculostomy-associated cerebrospinal fluid infection versus catheter-days.
See this image and copyright information in PMC

References

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