Acta Neurochirurgica

, Volume 161, Issue 3, pp 517–524 | Cite as

Risk factors for meningitis in neurosurgical patients with cerebrospinal fluid drains: prospective observational cohort study

  • Khetam HusseinEmail author
  • Galit Rabino
  • Omri Feder
  • Haneen Eghbaryeh
  • Hiba Zayyad
  • Gil Sviri
  • Rima Benenson
  • Mical Paul
Original Article - Infection
Part of the following topical collections:
  1. Topical Collection on Infection



Cerebrospinal fluid (CSF) drainage or intracranial pressure (ICP) monitoring devices are life-saving devices. We examined the risk factors for infections related to them and assessed the effect of an infection control (IC) intervention.


A prospective observational study was conducted in the Neurosurgical Department of our hospital between 2014 and 2017. We included all consecutive patients undergoing CSF catheter insertions, including external ventricular drainage (EVD), lumbar drainage (LD), and ICP catheters. An IC intervention was implemented between March and August 2016. We examined risk factors for meningitis or ventriculitis, defined according to Healthcare-associated infections surveillance definitions, on univariate and multivariate analysis.


A total of 232 patients with 437 drains (212 EVDs, 92 LDs, and 133 ICPs) were included. On univariate and multivariate analysis, the infection incidence was 13.7 per 1000 drain days (17.3/1000 before IC intervention, 7.9/1000 during, and 9.2/1000 after the intervention). Most episodes were caused by Gram-negative bacteria, and the most common pathogen was Acinetobacter baumanii. Risk factors for infection per patient included diabetes mellitus (p = 0.017), CSF leak (p = 0.032), drain opening (p = 0.027), and the duration of the drain in days (p = 0.035). Risk factors per catheter included drain opening (p < 0.001), drain days (p = 0.001), and the IC intervention period compared to before the intervention period (p = 0.037). When restricting the analysis to EVDs, drain days (p = 0.001) was the only significant risk factor.


Strict adherence to IC, shortening drain duration, and avoiding unnecessary opening and manipulation of the drains are crucial to preventing neurosurgical drain infections.


External ventricular drainage (EVD) Lumbar drainage (LD) Intracranial pressure (ICP) Infection Risk factors 



No funding was received for this research.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Helsinki Committee, Rambam Medical Center) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent was not required.

Supplementary material

701_2019_3801_MOESM1_ESM.docx (20 kb)
ESM 1 (DOCX 20 kb)


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Infectious Diseases InstituteRambam Health Care CampusHaifaIsrael
  2. 2.Rappaport Faculty of MedicineTechnion-Israel Institute of TechnologyHaifaIsrael
  3. 3.Department of NeurosurgeryRambam Health Care CampusHaifaIsrael

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