{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T16:10:52Z","timestamp":1779207052998,"version":"3.51.4"},"reference-count":32,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Background\/Objectives: External ventricular drains (EVDs) are widely used in the management of intracranial hemorrhage and hydrocephalus; however, they carry a significant risk of device-related central nervous system infections, including ventriculitis and meningitis, which are associated with increased morbidity, mortality, and prolonged intensive care stays. We conducted a systematic review and meta-analysis to evaluate whether prolonged EVD duration (&gt;10 days) is associated with an increased risk of ventriculostomy-related infection compared with shorter duration (\u226410 days), and to explore the association with cerebrospinal fluid (CSF) leak where data were available. Methods: A comprehensive literature search of PubMed, Google Scholar, Web of Science, and Cochrane CENTRAL was performed from database inception through September 2025, including English-language clinical trials, cohort studies, and case\u2013control studies reporting infection outcomes related to EVD management factors. Two reviewers independently screened studies and extracted data. A random-effects meta-analysis was conducted to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs). Results: Sixteen studies comprising approximately 5500 patients met the inclusion criteria. Shorter EVD duration (\u226410 days) was associated with a significantly lower risk of infection (pooled OR 0.45, 95% CI 0.30\u20130.68; p = 0.0002), corresponding to a 55% reduction in the odds of ventriculostomy-related infection. Prolonged EVD duration was consistently associated with increased infection risk across studies. Conclusions:These findings suggest that minimizing EVD duration may reduce infection risk and support early removal when clinically feasible. However, given the observational nature of the included studies, the results should be interpreted with caution. Further research is warranted to evaluate additional modifiable risk factors, including CSF leakage and sampling practices.<\/jats:p>","DOI":"10.3390\/brainsci16050528","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T15:17:23Z","timestamp":1779203843000},"page":"528","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["External Ventricular Drains and Infection Risk: Duration as the Dominant Predictor\u2014A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-9849-4006","authenticated-orcid":false,"given":"Thamer H.","family":"Alsharif","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, King Abdulaziz Specialist Hospital, Taif 26521, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3311-8091","authenticated-orcid":false,"given":"Badr E.","family":"Hafiz","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Jeddah 21499, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lamair","family":"Albakri","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Makkah Health Cluster, Makkah 21955, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdularhman D.","family":"Alofi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, King Abdulaziz Specialist Hospital, Taif 26521, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ziad","family":"Alzahrani","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Jeddah 21499, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0749-7307","authenticated-orcid":false,"given":"Yazid","family":"Maghrabi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, King Abdulaziz Medical City, Jeddah 21423, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Moajeb","family":"Alzahrani","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, King Abdulaziz Medical City, Jeddah 21423, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1016\/j.wneu.2017.07.012","article-title":"Cell index in the diagnosis of external Ventricular Drain-Related infections","volume":"106","author":"Lunardi","year":"2017","journal-title":"World Neurosurg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1800516","DOI":"10.2807\/1560-7917.ES.2018.23.46.1800516","article-title":"Prevalence of healthcare-associated infections, estimated incidence and composite antimicrobial resistance index in acute care hospitals and long-term care facilities: Results from two European point prevalence surveys, 2016 to 2017","volume":"23","author":"Suetens","year":"2018","journal-title":"Eurosurveillance"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1859","DOI":"10.1017\/ice.2022.23","article-title":"Risk factors and outcomes associated with external ventricular drain infections","volume":"43","author":"Walek","year":"2022","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"107752","DOI":"10.1016\/j.clineuro.2023.107752","article-title":"Heparin-binding protein as a marker of ventriculostomy related infection and central nervous system inflammation in neuro-intensive care","volume":"229","author":"Cederberg","year":"2023","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1007\/s00701-018-3745-z","article-title":"Incidence, depth, and severity of surgical site infections after neurosurgical interventions","volume":"161","author":"Stienen","year":"2018","journal-title":"Acta Neurochir."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1308\/rcsann.2019.0001","article-title":"Risk factors for surgical site infections in neurosurgery","volume":"101","author":"Patel","year":"2019","journal-title":"Ann. R. Coll. Surg. Engl."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"697","DOI":"10.2147\/IDR.S326456","article-title":"Current Perspectives on the diagnosis and Management of Healthcare-Associated Ventriculitis and Meningitis","volume":"15","author":"Karvouniaris","year":"2022","journal-title":"Infect. Drug Resist."},{"key":"ref_8","unstructured":"Centers for Disease Control and Prevention (CDC) (2026, May 10). Surgical Site Infection (SSI) Event, Available online: https:\/\/www.cdc.gov\/nhsn\/pdfs\/pscmanual\/9pscssicurrent.pdf."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1097\/00006123-200207000-00024","article-title":"Ventriculostomy-related Infections: A Critical Review of the literature","volume":"51","author":"Lozier","year":"2002","journal-title":"Neurosurgery"},{"key":"ref_10","first-page":"368","article-title":"Risk factors for infection associated with the use of external ventricular drainage: A systematic review with meta-analysis","volume":"162","author":"Canicoba","year":"2024","journal-title":"J. Hosp. Infect."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_12","unstructured":"(2026, May 10). PRISMA 2020 Flow Diagram\u2014PRISMA Statement. Available online: https:\/\/www.prisma-statement.org\/prisma-2020-flow-diagram."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1007\/s10654-010-9491-z","article-title":"Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses","volume":"25","author":"Stang","year":"2010","journal-title":"Eur. J. Epidemiol."},{"key":"ref_14","first-page":"48","article-title":"The risk factors of External Ventricular Drainage-Related Infection at Hospital Kuala Lumpur: An observational study","volume":"17","author":"Omar","year":"2015","journal-title":"Malays. J. Med. Sci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"188","DOI":"10.4103\/2152-7806.172533","article-title":"Role of external ventricular drainage in the management of intraventricular hemorrhage; its complications and management","volume":"6","author":"Kirmani","year":"2015","journal-title":"Surg. Neurol. Int."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.clineuro.2014.09.026","article-title":"External ventricular drain placement in the intensive care unit versus operating room: Evaluation of complications and accuracy","volume":"128","author":"Foreman","year":"2015","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1016\/j.wneu.2016.01.034","article-title":"Cerebrospinal Fluid Infection Associated with Silver-Impregnated External Ventricular Drain Catheters","volume":"89","author":"Atkinson","year":"2016","journal-title":"World Neurosurg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1016\/j.wneu.2016.12.071","article-title":"External ventricular Drain\u2013Related infection in spontaneous intracerebral hemorrhage","volume":"99","author":"Lima","year":"2017","journal-title":"World Neurosurg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e398","DOI":"10.1016\/j.wneu.2017.09.190","article-title":"Cerebrospinal fluid leak at percutaneous exit of ventricular catheter as a crucial risk factor for external ventricular Drainage\u2013Related infection in adult neurosurgical patients","volume":"109","author":"Park","year":"2017","journal-title":"World Neurosurg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.jocn.2017.05.042","article-title":"Moving the goalposts: A comparison of different definitions for primary external ventricular drain infection and its risk factors: A multi-center study of 2575 patients","volume":"45","author":"Woo","year":"2017","journal-title":"J. Clin. Neurosci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e135","DOI":"10.1016\/j.wneu.2017.10.129","article-title":"Infection Incidence Associated with External Ventriculostomy Placement: A Comparison of Outcomes in the Emergency Department, Intensive Care Unit, and Operating Room","volume":"110","author":"Kohli","year":"2018","journal-title":"World Neurosurg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e411","DOI":"10.1016\/j.wneu.2018.06.045","article-title":"Silver-Coated ventriculostomy catheters do not reduce rates of clinically diagnosed ventriculitis","volume":"117","author":"Nilsson","year":"2018","journal-title":"World Neurosurg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1771","DOI":"10.1007\/s00381-024-06344-5","article-title":"Comparative study between ventriculosubgaleal shunt and external ventricular drain for management of post infective hydrocephalus among pediatrics","volume":"40","author":"Taha","year":"2024","journal-title":"Child. Nerv. Syst."},{"key":"ref_24","first-page":"e7173","article-title":"A retrospective quality analysis of external ventricular drain infection rates following stroke diagnoses and other brain injuries: Comparison of emergency room and ICU\/OR setting","volume":"12","author":"Altschul","year":"2020","journal-title":"Cureus"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1007\/s00701-019-03801-y","article-title":"Risk factors for meningitis in neurosurgical patients with cerebrospinal fluid drains: Prospective observational cohort study","volume":"161","author":"Hussein","year":"2019","journal-title":"Acta Neurochir."},{"key":"ref_26","first-page":"12664","article-title":"Assessment of risk factors for external ventricular drainage-induced infections in the neurosurgery department","volume":"11","author":"Shang","year":"2018","journal-title":"Int. J. Clin. Exp. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e474","DOI":"10.1016\/j.wneu.2019.07.205","article-title":"Decreasing External Ventricular Drain-Related Infection Rates with Duration-Independent, Clinically Indicated Criteria for Drain Revision: A Retrospective Study","volume":"131","author":"Katzir","year":"2019","journal-title":"World Neurosurg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1007\/s00701-018-3508-x","article-title":"Recurrent sampling and ventriculostomy-associated infections: A case-control study","volume":"160","author":"Thompson","year":"2018","journal-title":"Acta Neurochir."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e1230","DOI":"10.1002\/cl2.1230","article-title":"PRISMA2020: An R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis","volume":"18","author":"Haddaway","year":"2022","journal-title":"Campbell Syst. Rev."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1007\/s10096-013-1895-8","article-title":"Assessment of the in vivo formation of biofilm on external ventricular drainages","volume":"32","author":"Soriano","year":"2013","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1159\/000319396","article-title":"Direct Demonstration of Staphylococcus Biofilm in an External Ventricular Drain in a Patient with a History of Recurrent Ventriculoperitoneal Shunt Failure","volume":"46","author":"Stoodley","year":"2010","journal-title":"Pediatr. Neurosurg."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Sorinola, A., Buki, A., Sandor, J., and Czeiter, E. (2019). Risk factors of external ventricular drain infection: Proposing a model for future studies. Front. Neurol., 10.","DOI":"10.3389\/fneur.2019.00226"}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/16\/5\/528\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T15:34:03Z","timestamp":1779204843000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/16\/5\/528"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,15]]},"references-count":32,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["brainsci16050528"],"URL":"https:\/\/doi.org\/10.3390\/brainsci16050528","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,15]]}}}