VENTRICULOSTOMY INFECTIONS - THE EFFECT OF MONITORING, DURATION AND CATHETER EXCHANGE IN 584 PATIENTS

The investigators undertook a retrospective analysis of ventriculostom y infections to evaluate their relationship to monitoring duration and prophylactic catheter exchange. In 1984, the results of an epidemiolo gical study of ventriculostomy-related infection were published. One o f the conclusions of the paper was that the incidence of ventriculosto my-related infections rose after 5 days of monitoring. This led to the recommendation that catheters be prophylactically changed at 5-day in tervals if prolonged monitoring was required. A recent randomized pros pective study on central venous catheters showed no reduction in infec tion with prophylactic catheter exchanges. This has led the authors to reexamine their experience with ventriculostomy infections. Data on 5 84 severely head injured patients with ventriculostomies were prospect ively collected in two data banks, The Traumatic Coma Data Bank and Th e Medical College of Virginia Neurocore Data Bank. These data were ret rospectively analyzed for factors associated with ventriculostomy rela ted infections. It was found that there is a relationship of ventricul itis to monitoring duration but it is not simple or Linear. There is a rising risk of infection over the first 10 days, but infection then b ecomes very unlikely despite a population that continues to be at risk . Patients in whom catheters were replaced prior to 5 days did not hav e a lower infection rate than those whose catheters were exchanged at more than 5-day intervals. Based on these data, it is recommended that ventriculostomy catheters for intracranial pressure monitoring be rem oved as quickly as possible, and in circumstances in which prolonged m onitoring is required, there appears to be no benefit from catheter ex change.