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Intracranial pressure monitors. Epidemiologic study of risk factors and infections
Abstract:
An increase in the number of cases of gram-negative ventriculomeningitis in patients followed with intracranial pressure monitors when compared with patients with craniotomy alone was revealed by routine surveillance data. A study was undertaken at four area institutions to describe the infections, risk factors, and management. Two hundred fifty-five patients with diagnoses of intracerebral hemorrhage (n = 86), closed trauma (n = 66), open trauma (n = 21), tumor (n = 66), and miscellaneous other conditions were compared with their nonmonitored counterparts for type of intracranial pressure monitor used, use of drains, prophylactic antibiotics, and steroids, and remote presence of infection. The presence of intracranial pressure monitor with craniotomy was associated with an 11 percent infection rate whereas craniotomy alone demonstrated a 6 percent rate. Of the intracranial pressure monitors used, the subarachnoid screw was associated with the lowest infection rate (7.5 percent) followed by the subdural cup catheter (14.9 percent) and the ventriculostomy catheter (21.9 percent). Regardless of the monitor used, infection was twice as likely to develop in patients with open trauma or hemorrhage. The use of bacitracin flush solutions for maintenance of lumen patency was more often associated with infections. Use of prophylactic antibiotics did not significantly influence outcome.
Insights
Intracranial pressure monitors increase ventriculomeningitis risk in neurosurgery patients. Subarachnoid screws show lower infection rates than other monitors, with open trauma and hemorrhage posing higher risks.
Area of Science:
- Neurosurgery
- Infectious Disease Epidemiology
Background:
- Gram-negative ventriculomeningitis cases increased in patients with intracranial pressure (ICP) monitors compared to craniotomy alone.
- Surveillance data indicated a need to investigate infections, risk factors, and management strategies.
Purpose of the Study:
- To describe the characteristics of ventriculomeningitis in patients with ICP monitors.
- To identify risk factors associated with these infections.
- To evaluate management strategies.
Main Methods:
- A comparative study at four institutions involving 255 patients with various neurological conditions (hemorrhage, trauma, tumor).
- Patients were analyzed based on ICP monitor type (subarachnoid screw, subdural cup catheter, ventriculostomy catheter), drain use, prophylactic antibiotics, steroids, and infection presence.
- Comparison was made between monitored and non-monitored patients.
Main Results:
- The infection rate was 11% for ICP monitor placement with craniotomy versus 6% for craniotomy alone.
- Subarachnoid screws had the lowest infection rate (7.5%), followed by subdural cup catheters (14.9%) and ventriculostomy catheters (21.9%).
- Open trauma and hemorrhage significantly increased infection likelihood (twice as likely). Bacitracin flush solutions were associated with higher infection rates.
Conclusions:
- ICP monitoring in neurosurgery is associated with an increased risk of ventriculomeningitis.
- The type of ICP monitor significantly impacts infection rates, with subarachnoid screws being the safest option.
- Specific patient conditions (open trauma, hemorrhage) and interventions (bacitracin flush) require careful consideration to mitigate infection risk.