title: Long subcutaneous tunnelling reduces infection rates in paediatric external ventricular drains.
abstract: OBJECTIVE
  The aim of this study is to report the efficacy of long subcutaneous tunnelling of external ventricular drains in reducing rates of infection and catheter displacement in a paediatric population.
  
  
  METHODS
  In children requiring external ventricular drainage, a long-tunnelled drain was placed and managed according to a locally agreed guideline. End points were novel CSF infection incurred during the time of drainage and re-operation to re-site displaced catheters. Data were compared to other published series.
  
  
  RESULTS
  One hundred eighty-one long-tunnelled external ventricular drains (LTEVDs) were inserted. The mean age was 6.6 years (range 0-15.5 years). Reasons for insertion included intraventricular haemorrhage (47 %), infection (27 %), tumour-related hydrocephalus (7.2 %), as a temporising measure (17 %) and trauma (2.2 %). The overall new infection rate for LTEVD was 2.76 %. If the 48 cases where LTEVDs were inserted to treat an existing infection are excluded, the infection rate was 3.8 % (5/133). The mean duration of insertion was 10 days (range 0-42 days). Four LTEVDs (2.2 %) were inadvertently dislodged, requiring reinsertion. Thirteen patients required removal of EVD alone. There was a significant difference (p < 0.05) when comparing our infection rate to 14 publications of infection rates in short-tunnelled EVDs; however, there was no difference when comparing our data to three publications using LTEVDs.
  
  
  CONCLUSIONS
  The use of an antibiotic-impregnated LTEVD, managed according to a predefined guideline, is associated with significantly reduced infection and displacement rates when compared with contemporary series. It is suggested that this reduction is of both clinical and economic benefits.
authors.affiliation: Southampton Medical School, University of Southampton, Southampton, UK, cc10g12@soton.ac.uk.
authors.forename: Christian D E
authors.initials: CD
authors.lastname: Collins
authors.forename: John C
authors.initials: JC
authors.lastname: Hartley
authors.forename: Aabir
authors.initials: A
authors.lastname: Chakraborty
authors.forename: Dominic N P
authors.initials: DN
authors.lastname: Thompson
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D020806:Central Nervous System Bacterial Infections / Q000209:etiology* / Q000517:prevention & control; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006470:Hemorrhage / Q000601:surgery; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery; D007223:Infant; D007231:Infant, Newborn; D007239:Infections / Q000188:drug therapy / Q000209:etiology* / Q000628:therapy*; D008137:Longitudinal Studies; D008297:Male; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology* / Q000517:prevention & control; D014696:Ventriculostomy / Q000009:adverse effects
chemical_list: D000900:Anti-Bacterial Agents