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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2000 Sep;69(3):381–384. doi: 10.1136/jnnp.69.3.381

Infection related to intracranial pressure monitors in adults: analysis of risk factors and antibiotic prophylaxis

J Rebuck 1, K Murry 1, D Rhoney 1, D Michael 1, W Coplin 1
PMCID: PMC1737112  PMID: 10945814

Abstract

OBJECTIVE—Infection is a complication related to intracranial pressure monitoring devices. The timing, duration, and role of prophylactic antimicrobial agents against intracranial pressure monitor (ICPM) related infection have not previously been well defined. Risk factors and selection, duration, and timing of antibiotic prophylaxis in patients with ICPMs were evaluated.
METHODS—Records of all consecutive patients who underwent ICPM insertion between 1993 and 1996 were reviewed. Patients included were older than 12 years with an ICPM placed for at least 24 hours. Exclusion criteria consisted of ICPM placed before admission or documented CSF infection before or at the time of insertion. Standard criteria were applied to all patients for diagnosis of CSF infection.
RESULTS—A total of 215 patients were included, 16 (7.4%) of whom developed CSF infection. Antibiotic prophylaxis for ICPM placement was administered to 63% of infected and 59% of non-infected patients. Vancomycin (60%) and cefazolin (34%) were used most often. Sixty per cent (6/16) of patients who developed infection and 45% (53/199) of those without CSF infection received their first antibiotic dose within the 2 hours before ICPM insertion. Risk factors for CSF infection included duration of monitoring greater than 5 days (RR 4.0 (1.3-11.9)); presence of ventriculostomy (RR 3.4 (1.0-10.7)); CSF leak (RR 6.3 (1.5-27.4)); concurrent systemic infection (RR 3.4 (1.2-9.5)); or serial ICPM (RR 4.9 (1.7-13.8)).
CONCLUSIONS—Administration of antibiotics to patients before or at the time of ICPM placement did not decrease the incidence of CSF infection. Patients found to be at greater risk for infection at our institution included duration of ICPM greater than 5 days, use of ventricular catheter, CSF leak, concurrent systemic infection, or serial ICPM.



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Selected References

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  1. Ambrose P. G., Owens R. C., Jr, Quintiliani R., Yeston N., Crowe H. M., Cunha B. A., Nightingale C. H. Antibiotic use in the critical care unit. Crit Care Clin. 1998 Apr;14(2):283–308. doi: 10.1016/s0749-0704(05)70396-1. [DOI] [PubMed] [Google Scholar]
  2. Aucoin P. J., Kotilainen H. R., Gantz N. M., Davidson R., Kellogg P., Stone B. Intracranial pressure monitors. Epidemiologic study of risk factors and infections. Am J Med. 1986 Mar;80(3):369–376. doi: 10.1016/0002-9343(86)90708-4. [DOI] [PubMed] [Google Scholar]
  3. Bader M. K., Littlejohns L., Palmer S. Ventriculostomy and intracranial pressure monitoring: in search of a 0% infection rate. Heart Lung. 1995 Mar-Apr;24(2):166–172. doi: 10.1016/s0147-9563(05)80012-3. [DOI] [PubMed] [Google Scholar]
  4. Bogdahn U., Lau W., Hassel W., Gunreben G., Mertens H. G., Brawanski A. Continuous-pressure controlled, external ventricular drainage for treatment of acute hydrocephalus--evaluation of risk factors. Neurosurgery. 1992 Nov;31(5):898–904. doi: 10.1227/00006123-199211000-00011. [DOI] [PubMed] [Google Scholar]
  5. Chan K. H., Mann K. S. Prolonged therapeutic external ventricular drainage: a prospective study. Neurosurgery. 1988 Oct;23(4):436–438. doi: 10.1227/00006123-198810000-00005. [DOI] [PubMed] [Google Scholar]
  6. Clark W. C., Muhlbauer M. S., Lowrey R., Hartman M., Ray M. W., Watridge C. B. Complications of intracranial pressure monitoring in trauma patients. Neurosurgery. 1989 Jul;25(1):20–24. doi: 10.1097/00006123-198907000-00004. [DOI] [PubMed] [Google Scholar]
  7. Classen D. C., Evans R. S., Pestotnik S. L., Horn S. D., Menlove R. L., Burke J. P. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med. 1992 Jan 30;326(5):281–286. doi: 10.1056/NEJM199201303260501. [DOI] [PubMed] [Google Scholar]
  8. Franges E. Z., Beideman M. E. Infections related to intracranial pressure monitoring. J Neurosci Nurs. 1988 Apr;20(2):94–103. doi: 10.1097/01376517-198804000-00005. [DOI] [PubMed] [Google Scholar]
  9. Garner J. S., Jarvis W. R., Emori T. G., Horan T. C., Hughes J. M. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988 Jun;16(3):128–140. doi: 10.1016/0196-6553(88)90053-3. [DOI] [PubMed] [Google Scholar]
  10. Holloway K. L., Barnes T., Choi S., Bullock R., Marshall L. F., Eisenberg H. M., Jane J. A., Ward J. D., Young H. F., Marmarou A. Ventriculostomy infections: the effect of monitoring duration and catheter exchange in 584 patients. J Neurosurg. 1996 Sep;85(3):419–424. doi: 10.3171/jns.1996.85.3.0419. [DOI] [PubMed] [Google Scholar]
  11. Indications for intracranial pressure monitoring. Brain Trauma Foundation. J Neurotrauma. 1996 Nov;13(11):667–679. doi: 10.1089/neu.1996.13.667. [DOI] [PubMed] [Google Scholar]
  12. Kanter R. K., Weiner L. B., Patti A. M., Robson L. K. Infectious complications and duration of intracranial pressure monitoring. Crit Care Med. 1985 Oct;13(10):837–839. doi: 10.1097/00003246-198510000-00012. [DOI] [PubMed] [Google Scholar]
  13. Lyons M. K., Meyer F. B. Cerebrospinal fluid physiology and the management of increased intracranial pressure. Mayo Clin Proc. 1990 May;65(5):684–707. doi: 10.1016/s0025-6196(12)65131-3. [DOI] [PubMed] [Google Scholar]
  14. Mayhall C. G., Archer N. H., Lamb V. A., Spadora A. C., Baggett J. W., Ward J. D., Narayan R. K. Ventriculostomy-related infections. A prospective epidemiologic study. N Engl J Med. 1984 Mar 1;310(9):553–559. doi: 10.1056/NEJM198403013100903. [DOI] [PubMed] [Google Scholar]
  15. Poon W. S., Ng S., Wai S. CSF antibiotic prophylaxis for neurosurgical patients with ventriculostomy: a randomised study. Acta Neurochir Suppl. 1998;71:146–148. doi: 10.1007/978-3-7091-6475-4_43. [DOI] [PubMed] [Google Scholar]
  16. Rosner M. J., Becker D. P. ICP monitoring: complications and associated factors. Clin Neurosurg. 1976;23:494–519. doi: 10.1093/neurosurgery/23.cn_suppl_1.494. [DOI] [PubMed] [Google Scholar]
  17. Schultz M., Moore K., Foote A. W. Bacterial ventriculitis and duration of ventriculostomy catheter insertion. J Neurosci Nurs. 1993 Jun;25(3):158–164. doi: 10.1097/01376517-199306000-00005. [DOI] [PubMed] [Google Scholar]
  18. Smith R. W., Alksne J. F. Infections complicating the use of external ventriculostomy. J Neurosurg. 1976 May;44(5):567–570. doi: 10.3171/jns.1976.44.5.0567. [DOI] [PubMed] [Google Scholar]
  19. Stenager E., Gerner-Smidt P., Kock-Jensen C. Ventriculostomy-related infections--an epidemiological study. Acta Neurochir (Wien) 1986;83(1-2):20–23. doi: 10.1007/BF01420503. [DOI] [PubMed] [Google Scholar]
  20. Winfield J. A., Rosenthal P., Kanter R. K., Casella G. Duration of intracranial pressure monitoring does not predict daily risk of infectious complications. Neurosurgery. 1993 Sep;33(3):424–431. doi: 10.1227/00006123-199309000-00011. [DOI] [PubMed] [Google Scholar]
  21. Wyler A. R., Kelly W. A. Use of antibiotics with external ventriculostomies. J Neurosurg. 1972 Aug;37(2):185–187. doi: 10.3171/jns.1972.37.2.0185. [DOI] [PubMed] [Google Scholar]

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