Summary of best evidence for prevention and management of intracranial infections related to lumbar drainage_West China Medical Journal

Authors：

ZHONG Yuxin ¹ , ZHANG Li ² , ZHANG Yahui ¹ ,  CHEN Jing ^1,2

1. School of Nursing, Guizhou Medical University, Guiyang, Guizhou 550004, P. R. China;
2. Department of Neurosurgery, the Second Affiliated Hospital of Guizhou Medical University, Kaili, Guizhou 556000, P. R. China;

Corresponding author：

CHEN Jing, Email: 1716974141@qq.com

Keywords：

Lumbar drainage; intracranial infection; prevention and management; summary of evidence

DOI：

10.7507/1002-0179.202406112

Video：

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Objective To retrieve, evaluate, and summarize evidence on the prevention and management of intracranial infections related to lumbar drainage (LD), in order to provide scientific references for clinical practice and decision-making. Methods The literature on the prevention and management of LD-related intracranial infections in LD-related websites and databases was systematically searched, with a search period from the establishment of databases to June 30, 2024. The included literature was evaluated for quality and integrated into evidence. Results A total of 9 articles were included, including 3 guidelines, 1 evidence summary, 1 expert consensus, 1 systematic review, and 3 original studies. A total of 30 pieces of evidence were formed, covering six aspects: risk management, catheter placement, catheter maintenance, extubation, diagnosis and treatment of intracranial infections, education and training. Conclusions The prevention and management of LD-related intracranial infections involve multiple pieces of evidence, and medical staff should selectively apply the best evidence based on patient and clinical conditions to reduce the incidence of intracranial infections and improve medical quality.

Citation： ZHONG Yuxin, ZHANG Li, ZHANG Yahui, CHEN Jing. Summary of best evidence for prevention and management of intracranial infections related to lumbar drainage. West China Medical Journal, 2025, 40(1): 74-80. doi: 10.7507/1002-0179.202406112 Copy

1.	Wolf S, Mielke D, Barner C, et al. Effectiveness of lumbar cerebrospinal fluid drain among patients with aneurysmal subarachnoid hemorrhage: a randomized clinical trial. JAMA Neurol, 2023, 80(8): 833-842.
2.	Badhiwala J, Lumba-Brown A, Hawryluk GWJ, et al. External lumbar drainage following traumatic intracranial hypertension: a systematic review and meta-analysis. Neurosurgery, 2021, 89(3): 395-405.
3.	Huo J, Qi Z, Chen S, et al. Neuroimage-based consciousness evaluation of patients with secondary doubtful hydrocephalus before and after lumbar drainage. Neurosci Bull, 2020, 36(9): 985-996.
4.	Arts S, van Lindert EJ, Aquarius R, et al. Complications of external cerebrospinal fluid drainage in aneurysmal subarachnoid haemorrhage. Acta Neurochir (Wien), 2021, 163(4): 1143-1151.
5.	Li G, Zhang Y, Zhao J, et al. Some cool considerations of external lumbar drainage during its widespread application in neurosurgical practice: a long way to go. Chin Neurosurg J, 2016, 2(02): 117-124.
6.	Savin I, Ershova K, Kurdyumova N, et al. Healthcare-associated ventriculitis and meningitis in a neuro-ICU: incidence and risk factors selected by machine learning approach. J Crit Care, 2018, 45: 95-104.
7.	朱政, 胡雁, 邢唯杰, 等. 不同类型循证问题的构成. 护士进修杂志, 2017, 32(21): 1991-1994.
8.	Brouwers MC, Kho ME, Browman GP, et al. AGREE II: advancing guideline development, reporting, and evaluation in health care. Prev Med, 2010, 51(5): 421-424.
9.	Buccheri RK, Sharifi C. Critical appraisal tools and reporting guidelines for evidence-based practice. Worldviews Evid Based Nurs, 2017, 14(6): 463-472.
10.	Foster MJ, Shurtz S. Making the critical appraisal for summaries of evidence (CASE) for evidence-based medicine (EBM): critical appraisal of summaries of evidence. J Med Libr Assoc, 2013, 101(3): 192-198.
11.	王春青, 胡雁. JBI 证据预分级及证据推荐级别系统(2014 版). 护士进修杂志, 2015(11): 964-967.
12.	Lele AV, Hoefnagel AL, Schloemerkemper N, et al. Perioperative management of adult patients with external ventricular and lumbar drains: guidelines from the society for neuroscience in anesthesiology and critical care. J Neurosurg Anesthesiol, 2017, 29(3): 191-210.
13.	Tunkel AR, Hasbun R, Bhimraj A, et al. 2017 Infectious Diseases Society of America’s clinical practice guidelines for healthcare-associated ventriculitis and meningitis. Clin Infect Dis, 2017, 64(6): e34-e65.
14.	Slazinski T, Anderson T, Cattell E, et al. Care of the patient undergoing intracranial pressure monitoring/external ventricular drainage or lumbar drainage. Glenview: American Association of Neuroscience Nurses, 2011, 43: 1-38.
15.	中华医学会神经外科学分会, 中国神经外科重症管理协作组. 神经外科脑脊液外引流中国专家共识(2018 版). 中华医学杂志, 2018, 98(21): 1646-1649.
16.	马慧, 杨诞凤, 毛仁玲. 脑脊液外引流管理证据转化及应用效果. 中国实用护理杂志, 2021, 37(7): 505-510.
17.	Konstantelias AA, Vardakas KZ, Polyzos KA, et al. Antimicrobial-impregnated and -coated shunt catheters for prevention of infections in patients with hydrocephalus: a systematic review and meta-analysis. J Neurosurg, 2015, 122(5): 1096-1112.
18.	Qian L, Shi Y, Li F, et al. Metagenomic next-generation sequencing of cerebrospinal fluid for the diagnosis of external ventricular and lumbar drainage-associated ventriculitis and meningitis. Front Microbiol, 2020, 11: 596175.
19.	Hussein K, Rabino G, Feder O, et al. Risk factors for meningitis in neurosurgical patients with cerebrospinal fluid drains: prospective observational cohort study. Acta Neurochir (Wien), 2019, 161(3): 517-524.
20.	Jakobs M, Klein S, Eigenbrod T, et al. The SiLuDrain trial: a prospective randomized controlled trial comparing standard versus silver-impregnated lumbar drains. J Neurosurg, 2018, 130(6): 2040-2047.
21.	Wang P, Song W, Cheng S, et al. Establishment of a nomogram for predicting lumbar drainage-related meningitis: a simple tool to estimate the infection risk. Neurocrit Care, 2021, 34(2): 557-565.
22.	Scheithauer S, Bürgel U, Ryang YM, et al. Prospective surveillance of drain associated meningitis/ventriculitis in a neurosurgery and neurological intensive care unit. J Neurol Neurosurg Psychiatry, 2009, 80(12): 1381-1385.
23.	Leverstein-van Hall MA, Hopmans TE, van der Sprenkel JW, et al. A bundle approach to reduce the incidence of external ventricular and lumbar drain-related infections. J Neurosurg, 2010, 112(2): 345-353.
24.	Lewis A, Rothstein A, Pacione D. Results of a quality improvement initiative reassessing an institutional lumbar drain infection prevention protocol. J Neurosurg Spine, 2018, 29(1): 54-58.
25.	Chan CH, Desai SR, Hwang NC. Cerebrospinal fluid drains: risks in contemporary clinical practice. J Cardiothorac Vasc Anesth, 2022, 36(8): 2685-2699.
26.	Rass V, Kofler M, Beer R, et al. Invasive neuromonitoring and neurological intensive care unit management in life-threatening central nervous system infections. Curr Opin Neurol, 2021, 34(3): 447-455.
27.	马修尧, 刘彬, 任超, 等. 脑动脉瘤术后腰大池置管引流患者颅内感染及影响因素. 中国感染控制杂志, 2019, 18(7): 660-664.
28.	Bakhshi SK, Suhail N, Mitha R, et al. Lumbar drain for temporary cerebrospinal fluid diversion: factors related to the risks of complications at a university hospital. World Neurosurg, 2020, 143: e193-e198.
29.	Jamjoom AAB, Joannides AJ, Poon MT, et al. Prospective, multicentre study of external ventricular drainage-related infections in the UK and Ireland. J Neurol Neurosurg Psychiatry, 2018, 89(2): 120-126.
30.	Chen C, Zhang B, Yu S, et al. The incidence and risk factors of meningitis after major craniotomy in China: a retrospective cohort study. PLoS One, 2014, 9(7): e101961.
31.	吴胜青, 曾振坤, 黄建顺, 等. 改良皮下隧道式腰大池外引流置管和常规腰大池置管法在临床中的效果对比. 中外医学研究, 2020, 18(20): 36-38.
32.	Wilson MR, Sample HA, Zorn KC, et al. Clinical metagenomic sequencing for diagnosis of meningitis and encephalitis. N Engl J Med, 2019, 380(24): 2327-2340.
33.	Giovane RA, Lavender PD. Central nervous system infections. Prim Care, 2018, 45(3): 505-518.
34.	Karvouniaris M, Brotis A, Tsiakos K, et al. Current perspectives on the diagnosis and management of healthcare-associated ventriculitis and meningitis. Infect Drug Resist, 2022, 15: 697-721.
35.	李银花, 马青. 个体精细化管理在腰大池引流病人中的应用. 护理研究, 2021, 35(14): 2627-2629.

1. Wolf S, Mielke D, Barner C, et al. Effectiveness of lumbar cerebrospinal fluid drain among patients with aneurysmal subarachnoid hemorrhage: a randomized clinical trial. JAMA Neurol, 2023, 80(8): 833-842.
2. Badhiwala J, Lumba-Brown A, Hawryluk GWJ, et al. External lumbar drainage following traumatic intracranial hypertension: a systematic review and meta-analysis. Neurosurgery, 2021, 89(3): 395-405.
3. Huo J, Qi Z, Chen S, et al. Neuroimage-based consciousness evaluation of patients with secondary doubtful hydrocephalus before and after lumbar drainage. Neurosci Bull, 2020, 36(9): 985-996.
4. Arts S, van Lindert EJ, Aquarius R, et al. Complications of external cerebrospinal fluid drainage in aneurysmal subarachnoid haemorrhage. Acta Neurochir (Wien), 2021, 163(4): 1143-1151.
5. Li G, Zhang Y, Zhao J, et al. Some cool considerations of external lumbar drainage during its widespread application in neurosurgical practice: a long way to go. Chin Neurosurg J, 2016, 2(02): 117-124.
6. Savin I, Ershova K, Kurdyumova N, et al. Healthcare-associated ventriculitis and meningitis in a neuro-ICU: incidence and risk factors selected by machine learning approach. J Crit Care, 2018, 45: 95-104.
7. 朱政, 胡雁, 邢唯杰, 等. 不同类型循证问题的构成. 护士进修杂志, 2017, 32(21): 1991-1994.
8. Brouwers MC, Kho ME, Browman GP, et al. AGREE II: advancing guideline development, reporting, and evaluation in health care. Prev Med, 2010, 51(5): 421-424.
9. Buccheri RK, Sharifi C. Critical appraisal tools and reporting guidelines for evidence-based practice. Worldviews Evid Based Nurs, 2017, 14(6): 463-472.
10. Foster MJ, Shurtz S. Making the critical appraisal for summaries of evidence (CASE) for evidence-based medicine (EBM): critical appraisal of summaries of evidence. J Med Libr Assoc, 2013, 101(3): 192-198.
11. 王春青, 胡雁. JBI 证据预分级及证据推荐级别系统(2014 版). 护士进修杂志, 2015(11): 964-967.
12. Lele AV, Hoefnagel AL, Schloemerkemper N, et al. Perioperative management of adult patients with external ventricular and lumbar drains: guidelines from the society for neuroscience in anesthesiology and critical care. J Neurosurg Anesthesiol, 2017, 29(3): 191-210.
13. Tunkel AR, Hasbun R, Bhimraj A, et al. 2017 Infectious Diseases Society of America’s clinical practice guidelines for healthcare-associated ventriculitis and meningitis. Clin Infect Dis, 2017, 64(6): e34-e65.
14. Slazinski T, Anderson T, Cattell E, et al. Care of the patient undergoing intracranial pressure monitoring/external ventricular drainage or lumbar drainage. Glenview: American Association of Neuroscience Nurses, 2011, 43: 1-38.
15. 中华医学会神经外科学分会, 中国神经外科重症管理协作组. 神经外科脑脊液外引流中国专家共识(2018 版). 中华医学杂志, 2018, 98(21): 1646-1649.
16. 马慧, 杨诞凤, 毛仁玲. 脑脊液外引流管理证据转化及应用效果. 中国实用护理杂志, 2021, 37(7): 505-510.
17. Konstantelias AA, Vardakas KZ, Polyzos KA, et al. Antimicrobial-impregnated and -coated shunt catheters for prevention of infections in patients with hydrocephalus: a systematic review and meta-analysis. J Neurosurg, 2015, 122(5): 1096-1112.
18. Qian L, Shi Y, Li F, et al. Metagenomic next-generation sequencing of cerebrospinal fluid for the diagnosis of external ventricular and lumbar drainage-associated ventriculitis and meningitis. Front Microbiol, 2020, 11: 596175.
19. Hussein K, Rabino G, Feder O, et al. Risk factors for meningitis in neurosurgical patients with cerebrospinal fluid drains: prospective observational cohort study. Acta Neurochir (Wien), 2019, 161(3): 517-524.
20. Jakobs M, Klein S, Eigenbrod T, et al. The SiLuDrain trial: a prospective randomized controlled trial comparing standard versus silver-impregnated lumbar drains. J Neurosurg, 2018, 130(6): 2040-2047.
21. Wang P, Song W, Cheng S, et al. Establishment of a nomogram for predicting lumbar drainage-related meningitis: a simple tool to estimate the infection risk. Neurocrit Care, 2021, 34(2): 557-565.
22. Scheithauer S, Bürgel U, Ryang YM, et al. Prospective surveillance of drain associated meningitis/ventriculitis in a neurosurgery and neurological intensive care unit. J Neurol Neurosurg Psychiatry, 2009, 80(12): 1381-1385.
23. Leverstein-van Hall MA, Hopmans TE, van der Sprenkel JW, et al. A bundle approach to reduce the incidence of external ventricular and lumbar drain-related infections. J Neurosurg, 2010, 112(2): 345-353.
24. Lewis A, Rothstein A, Pacione D. Results of a quality improvement initiative reassessing an institutional lumbar drain infection prevention protocol. J Neurosurg Spine, 2018, 29(1): 54-58.
25. Chan CH, Desai SR, Hwang NC. Cerebrospinal fluid drains: risks in contemporary clinical practice. J Cardiothorac Vasc Anesth, 2022, 36(8): 2685-2699.
26. Rass V, Kofler M, Beer R, et al. Invasive neuromonitoring and neurological intensive care unit management in life-threatening central nervous system infections. Curr Opin Neurol, 2021, 34(3): 447-455.
27. 马修尧, 刘彬, 任超, 等. 脑动脉瘤术后腰大池置管引流患者颅内感染及影响因素. 中国感染控制杂志, 2019, 18(7): 660-664.
28. Bakhshi SK, Suhail N, Mitha R, et al. Lumbar drain for temporary cerebrospinal fluid diversion: factors related to the risks of complications at a university hospital. World Neurosurg, 2020, 143: e193-e198.
29. Jamjoom AAB, Joannides AJ, Poon MT, et al. Prospective, multicentre study of external ventricular drainage-related infections in the UK and Ireland. J Neurol Neurosurg Psychiatry, 2018, 89(2): 120-126.
30. Chen C, Zhang B, Yu S, et al. The incidence and risk factors of meningitis after major craniotomy in China: a retrospective cohort study. PLoS One, 2014, 9(7): e101961.
31. 吴胜青, 曾振坤, 黄建顺, 等. 改良皮下隧道式腰大池外引流置管和常规腰大池置管法在临床中的效果对比. 中外医学研究, 2020, 18(20): 36-38.
32. Wilson MR, Sample HA, Zorn KC, et al. Clinical metagenomic sequencing for diagnosis of meningitis and encephalitis. N Engl J Med, 2019, 380(24): 2327-2340.
33. Giovane RA, Lavender PD. Central nervous system infections. Prim Care, 2018, 45(3): 505-518.
34. Karvouniaris M, Brotis A, Tsiakos K, et al. Current perspectives on the diagnosis and management of healthcare-associated ventriculitis and meningitis. Infect Drug Resist, 2022, 15: 697-721.
35. 李银花, 马青. 个体精细化管理在腰大池引流病人中的应用. 护理研究, 2021, 35(14): 2627-2629.

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