Risk Factors Associated with Infections and Need for Permanent Cerebrospinal Fluid Diversion in Pediatric Intensive Care Patients with Externalized Ventricular Drains

Topjian, Alexis; Stuart, Amber; Pabalan, Alyssa A.; Clair, Ashleigh; Kilbaugh, Todd J.; Abend, Nicholas S.; Berg, Robert A.; Heuer, Gregory G.; Storm, Phillip B.; Huh, Jimmy W.; Friess, Stuart H.

doi:10.1007/s12028-013-9946-7

Cited by 16 publications

(22 citation statements)

References 22 publications

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“…This dataset was previously published evaluating the association of EVDs and infection (15). This study was approved by the hospital Institutional Review Board and the requirement for obtaining informed consent was waived.…”

Section: Methodsmentioning

confidence: 99%

Greater Fluctuations in Serum Sodium Levels Are Associated With Increased Mortality in Children With Externalized Ventriculostomy Drains in a PICU*

Topjian¹,

Stuart²,

Pabalan³

et al. 2014

Pediatric Critical Care Medicine

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Objective Dysnatremia is common in critically ill children due to disruption of hormonal homeostasis. Children with brain injury are at risk for SIADH, cerebral salt wasting and sodium losses due to externalized ventricular drain (EVD) placement. We hypothesized that among pediatric intensive care unit (PICU) patients managed with an EVD, hyponatremia is common, hyponatremia is associated with seizures and in-hospital mortality, and greater sodium fluctuations are associated with in-hospital mortality. Design Retrospective observational study Setting Tertiary care PICU Patients All pediatric patients treated in the PICU with an EVD from January 2005 to December 2009. Patients were identified by searching the physician order entry database for EVD orders. Hyponatremia was defined as the minimum sodium during patients’ EVD time and was categorized as mild (131-134 meq/L) or moderate-severe (≤130 meq/L). Magnitude of sodium fluctuation was defined as the difference between a patient’s highest and lowest sodium during the time in which an EVD was in use (up to 14 days). Seizure was defined as a clinically evident convulsion during EVD presence. A priori confounders were age, history of epilepsy, and EVD indication. Multivariable regression was performed to test the association between sodium derangements and outcomes. Interventions None. Measurements and Main Results Three hundred eighty patients were eligible. One hundred nine (29%) had mild hyponatremia, and 30 (8%) moderate-severe hyponatremia. Twenty eight (7%) patients had a seizure while hospitalized. Eighteen patients died (5%) prior to discharge. Survivors had a median daily sodium fluctuation of 1 [0, 5] vs non-survivors 9 [6, 11], (p< 0.001) and a median sodium fluctuation of 5 meq/L [interquartile range 2, 8] vs non-survivors 15 meq/L [9, 24] (p<0.001) during EVD management. After controlling for a priori covariates and potential confounders, hyponatremia was not associated with an increased odds of seizures or in-hospital mortality. However, greater fluctuations in daily sodium (OR 1.38, 95% CI (1.06, 1.8)) and greater fluctuations in sodium during EVD management were associated with increased odds of in-hospital mortality (OR 1.59, 95% CI (1.2, 2.11)). Conclusion Hyponatremia was common in PICU patients treated with EVDs but not associated with seizures or in-hospital mortality. Greater sodium fluctuations during EVD management were independently associated with increased odds of in-hospital mortality.

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Section: Methodsmentioning

confidence: 99%

Greater Fluctuations in Serum Sodium Levels Are Associated With Increased Mortality in Children With Externalized Ventriculostomy Drains in a PICU*

Topjian¹,

Stuart²,

Pabalan³

et al. 2014

Pediatric Critical Care Medicine

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“…In comparison to our previously published cohort, the infection rate with antibiotic-impregnated EVDs is significantly lower than nonantibiotic-impregnated EVDs (0.9% vs 6%, p = 0.00128). 15…”

Section: Resultsmentioning

confidence: 99%

“…A z-test for differences in two proportions was used to assess the difference in positive culture rate between the current study and the previously published study (2005)(2006)(2007)(2008)(2009)). 15…”

Section: Discussionmentioning

confidence: 99%

“…tors associated with EVD infections in patients treated with nonantibiotic-impregnated catheters; the infection rate was 8.6 per 1000 catheter (EVD) days. 15 In the adult neurosurgical population, there has been increasing use of antibiotic-impregnated EVD catheters. Some studies in adults have demonstrated that the use of antibiotic-impregnated EVD catheters has decreased the EVD-associated infection rate, whereas others have not.…”

mentioning

confidence: 99%

“…This study tests the hypothesis that the use of antibioticimpregnated EVD catheters in our pediatric neurosurgical patients demonstrates a decrease in the EVD-associated infection rate compared to our previous study with nonantibiotic-impregnated EVD catheters. 15…”

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confidence: 99%

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Reduction of ventriculostomy-associated CSF infection with antibiotic-impregnated catheters in pediatric patients: a single-institution study

Lang

Zhang

Yver

et al. 2019

Neurosurgical Focus

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OBJECTIVEExternal 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. The authors previously published a large pediatric cohort study analyzing nonantibiotic-impregnated EVD catheters and risk factors associated with infections. In this study, they aimed to analyze the EVD-associated infection rate after implementation of antibiotic-impregnated EVD catheters.METHODSA retrospective observational cohort of pediatric patients (younger than 18 years of age) who underwent a burr hole for antibiotic-impregnated EVD placement and who were admitted to a quaternary care ICU between January 2011 and January 2019 were reviewed. The ventriculostomy-associated infection rate in patients with antibiotic-impregnated EVD catheters was compared to the authors’ historical control of patients with nonantibiotic-impregnated EVD catheters.RESULTSTwo hundred twenty-nine patients with antibiotic-impregnated EVD catheters were identified. Neurological diagnostic categories included externalization of an existing shunt (externalized shunt) in 34 patients (14.9%); brain tumor (tumor) in 77 patients (33.6%); intracranial hemorrhage (ICH) in 27 patients (11.8%); traumatic brain injury (TBI) in 6 patients (2.6%); and 85 patients (37.1%) were captured in an “other” category. Two of 229 patients (0.9% of all patients) had CSF infections associated with EVD management, totaling an infection rate of 0.99 per 1000 catheter days. This is a significantly lower infection rate than was reported in the authors’ previously published analysis of the use of nonantibiotic-impregnated EVD catheters (0.9% vs 6%, p = 0.00128).CONCLUSIONSIn their large pediatric cohort, the authors demonstrated a significant decline in ventriculostomy-associated CSF infection rate after implementation of antibiotic-impregnated EVD catheters at their institution.

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Neurochirurgische Intensivmedizin

Ehlen¹,

Fremerey²

2018

Pädiatrische Neurochirurgie

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Risk Factors Associated with Infections and Need for Permanent Cerebrospinal Fluid Diversion in Pediatric Intensive Care Patients with Externalized Ventricular Drains

Cited by 16 publications

References 22 publications

Greater Fluctuations in Serum Sodium Levels Are Associated With Increased Mortality in Children With Externalized Ventriculostomy Drains in a PICU*

Greater Fluctuations in Serum Sodium Levels Are Associated With Increased Mortality in Children With Externalized Ventriculostomy Drains in a PICU*

Reduction of ventriculostomy-associated CSF infection with antibiotic-impregnated catheters in pediatric patients: a single-institution study

Neurochirurgische Intensivmedizin

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