title: Risk factors associated with infections and need for permanent cerebrospinal fluid diversion in pediatric intensive care patients with externalized ventricular drains.
abstract: BACKGROUND
  Externalized ventricular drains (EVDs) are commonly used in pediatric intensive care units (PICU) but few data are available regarding infection rates, infection risks, or factors associated with conversion to permanent cerebrospinal fluid (CSF) diversion.
  
  
  METHODS
  Retrospective observational study of patients managed with EVDs admitted to a tertiary care PICU from January 2005 to December 2009.
  
  
  RESULTS
  Three hundred eighty patients were identified. Neurologic diagnostic groups were externalization of existing shunt in 196 patients (52 %), brain tumor in 122 patients (32 %), intracranial hemorrhage in 23 patients (6 %), traumatic brain injury in 17 patients (5 %), meningitis in 9 patients (2 %), or other in 13 patients (3 %). Six percent of all patients (24/380) had new infections associated with EVD management for an infection rate of 8.6 per 1,000 catheter days. The median time to positive cultures was 7 days (interquartile range 4.75, 9) after EVD placement. Patients with EVD infections had significantly longer EVD duration 6 versus 11.5 days (p = 0.0001), and higher maximum EVD outputs 1.9 versus 1.5 mL/kg/h (p = 0.0017). Need for permanent CSF diversion was associated with higher maximum EVD drainage (1.3 vs. 1.6 mL/kg/h p < 0.0001), longer EVD duration (5 vs. 4 days, p < 0.005), and younger age (4.5 vs. 8 years, p < 0.02) but not intracranial hypertension (72 vs. 82 % of patients, p = 0.4).
  
  
  CONCLUSIONS
  In our large pediatric cohort, EVD infections were associated with longer EVD duration and higher maximum EVD output. Permanent CSF diversion was more likely in patients with higher maximum EVD drainage, longer EVD duration, and younger age.
authors: Department of Anesthesia and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors: Alexis A
authors: AA
authors: Topjian
authors: Amber
authors: A
authors: Stuart
authors: Alyssa A
authors: AA
authors: Pabalan
authors: Ashleigh
authors: A
authors: Clair
authors: Todd J
authors: TJ
authors: Kilbaugh
authors: Nicholas S
authors: NS
authors: Abend
authors: Robert A
authors: RA
authors: Berg
authors: Gregory G
authors: GG
authors: Heuer
authors: Phillip B
authors: PB
authors: Storm
authors: Jimmy W
authors: JW
authors: Huh
authors: Stuart H
authors: SH
authors: Friess
mesh_terms: D000293:Adolescent; D002408:Catheters, Indwelling / Q000009:adverse effects* / Q000382:microbiology / Q000706:statistics & numerical data; D002557:Cerebrospinal Fluid Shunts / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D004322:Drainage / Q000009:adverse effects* / Q000295:instrumentation / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D008297:Male; D012307:Risk Factors; D014696:Ventriculostomy / Q000009:adverse effects* / Q000706:statistics & numerical data