249. Reduction Of Ventriculostomy-Associated CSF Infection With Antibiotic-Impregnated Catheters In Pediatric Patients: A Single-Institution study

Authors: Jillian Ploof, DO; Shih-Shan Lang, MD; Bingqing Zhang, MPH; Hugues Yver, MD; Judy Palma, BS; Matthew Kirschen, MD; Alexis Topjian; Benjamin Kennedy, MD; Phillip Storm, MD; Gregory Heuer, MD, PhD; Janell Mensinger, PhD; Jimmy Huh, MD (Philadelphia, PA)

Introduction:

Externalized ventricular drains (EVDs) are commonly used in the neurosurgical population. However, very few pediatric neurosurgery studies are available regarding EVD-associated infection rates with antibiotic-impregnated EVD catheters. We previously published a large pediatric cohort study analyzing non-antibiotic impregnated EVD catheters and risk factors associated with infections. We aimed to analyze the EVD-associated infection rate after implementation of antibiotic-impregnated EVD catheters.

Methods:

A retrospective observational cohort study of pediatric patients (less than 18 years of age) who underwent a burr hole for antibiotic-impregnated EVD placement and admitted to a quaternary care ICU from January 2011 to January 2019 were reviewed. Ventriculostomy-associated infection rate in patients with antibiotic-impregnated EVD catheters was compared to our historical control of patients with non-antibiotic impregnated EVD catheters.

Results:

Two hundred and twenty-nine patients with antibiotic-impregnated EVD catheters were identified. Neurologic diagnostic categories included externalization of an existing shunt (Ext shunt) in 34 patients (14.8%), brain tumor (Tumor) in 77 patients (33.6 %), intracranial hemorrhage (ICH) in 27 patients (11.7%), traumatic brain injury (TBI) in 6 patients (2.6%), and 85 patients (37.1%) were captured in an “other” category. Two of 229 patients or 0.9% of all patients had CSF infections associated with EVD management totaling an infection rate of 0.99 per 1,000 catheter days. This is a significantly lower infection rate from our previous published analysis using non-antibiotic impregnated EVD catheters (0.9% vs 6%, p = 0.00128).

 

Conclusion:

In our large pediatric cohort, we demonstrated a significant decline in ventriculostomy associated CSF infection rate after our institutional implementation of antibiotic-impregnated EVD catheters.