SynthesisNeurosurgical review2026
Is there a way to reduce the infection associated with external ventricular shunts? A systematic review and meta-analysis of the recent bundle of care.
Synthesis in Neurosurgical review, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
2 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Routine versus clinically indicated cerebrospinal fluid sampling for infection in external ventricular drains: a systematic review.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026Pooled it
- Incidence, risk factors, and microbial spectrum of external ventricular drain-related infections among adult neurocritical care patients: A systematic review and meta-analysis.Journal of the Intensive Care Society · 2026Article
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAlthough external ventricular drains (EVDs) are crucial in neurosurgical care, they carry a high risk of healthcare-associated ventriculitis, with reported infection rates. Numerous interventions were thought to aid in infection control, but there is still an ongoing increase in infection incidence. Recently, bundled interventions with standardized protocols, antimicrobial-impregnated catheters, tunneling techniques, chlorhexidine dressings, and limited antibiotic prophylaxis have shown an interesting efficacy in shunt-related infection control.
methodsA systematic review was conducted using PubMed, Scopus, Google Scholar, Cochrane CENTRAL, and Web of Science to search for published articles on care bundles with at least three discrete preventive measures. Data analysis was performed using R software, estimating mean difference and risk ratios.
resultsSeventeen studies (9 quasi-experimental, 6 retrospective, and 2 prospective cohorts) were included in this study. Implementation of bundle care was associated with a significant reduction in the following outcomes: infection risk and drain stay duration (pooled RR = 0.32; 95% CI 0.20-0.51; p = 0.0001; I²=73.7%), (pooled MD=-1.57; 95% CI -5.80-2.67; p = 0.0038; I²=0%), respectively. Interestingly, there was no significant difference in risk with bundle of care regarding mortality (pooled RR = 1.09; 95% CI 0.62-1.92; p = 0.6924; I²=63.5%). However, no significant differences were observed in ventriculitis rates or hospital stay duration, with p = 0.0509, p = 0.3855, respectively.
conclusionsBundle of care implementation significantly reduced infection risk and drain days among patients with external ventricular drains, but failed to reduce ventriculitis, mortality, and hospital stay duration. These findings support approving standardized care bundles to improve outcomes, though further high-quality research is needed to assess their impact on specific complications like ventriculitis, mortality, and hospital stay.
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