Article
Catheter-associated meningitis in paediatric patients after brain surgery – incidence and risk factors
Katheter-assoziierte Meningitis bei pädiatrischen Patienten nach Hirnoperation – Inzidenz und Risikofaktoren
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Published: | May 8, 2019 |
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Objective: External ventricular drainage (EVD) is frequently used in pediatric brain surgery. During the externalization of cerebrospinal fluid (CSF), catheter-associated meningitis (CAM) remains a major issue. This study aimed to evaluate the incidence of CAM in a pediatric population and to elucidate major risk factors.
Methods: We analyzed retrospectively the medical and radiological records of 205 pediatric patients receiving 251 EVDs between January 2008 and December 2017. Inclusion criteria were: age ≤18 years, patients undergoing brain surgery and EVD insertion within 24 hours prior/after surgery. Patients who had a central nervous system (CNS) infection at the time of EVD insertion were excluded from the study. Infections were considered drain-related if at the time of the CNS infection, the drain had been in place for at least 48 hours.
Results: Of 205 patients, a total of 118 patients receiving 130 EVDs insertions were included for study purposes. The incidence of CAM was 17.8% (21/118). Mean time-to-infection was 5 days ±4.2. CAM prolonged the period of drainage in 61.9% of the cases (13/21). Postoperative CSF leakage along the catheter was statistically associated with CAM. Prolonged drainage (>7 days) as well as an extended ICU abidance were statistically associated, and each variable showed a statistically significant association with CAM.
Conclusion: pediatric patients, the first postoperative days on the ICU remain challenging and represent a critical period for the EVD, where CSF leakage along the EVD tunnel is likely to happen, possibly leading to a CAM. Measures to prevent CSF leakage and to reduce the incidence of CAM are needed especially in the pediatric population that is more prone to infections than adults.