Infection related to intracranial pressure monitors in adults: analysis of risk factors and antibiotic prophylaxis.
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.
Rebuck
J A
JA
Department of Pharmacy, Detroit Receiving Hospital and University Health Centre, 4201 Saint Antoine, Detroit, MI 48201, USA.
Murry
K R
KR
Rhoney
D H
DH
Michael
D B
DB
Coplin
W M
WM
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D002404:Catheterization; D002437:Cefazolin / Q000627:therapeutic use; D002493:Central Nervous System Diseases / Q000209:etiology / Q000382:microbiology*; D002511:Cephalosporins / Q000627:therapeutic use; D002555:Cerebrospinal Fluid / Q000382:microbiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007239:Infections / Q000209:etiology; D007427:Intracranial Pressure; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D014640:Vancomycin / Q000627:therapeutic use; D014696:Ventriculostomy
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D014640:Vancomycin; D002437:Cefazolin