Infection related to intracranial pressure monitors in adults: analysis ofrisk factors and antibiotic prophylaxis

Objective-Infection is a complication related to intracranial pressure moni toring devices. The timing, duration, and role of prophylactic antimicrobia l agents against intracranial pressure monitor (ICPM) related infection hav e not previously been well defined. Risk factors and selection, duration, a nd timing of antibiotic prophylaxis in patients with ICPMs were evaluated. Methods-Records of all consecutive patients who underwent ICPM insertion be tween 1993 and 1996 were reviewed. Patients included were older than 12 yea rs with an ICPM placed for at least 24 hours. Exclusion criteria consisted of ICPM placed before admission or documented CSF infection before or at th e time of insertion. Standard criteria were applied to all patients for dia gnosis 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 t o 63% of infected and 59% of non-infected patients. Vancomycin (60%) and ce fazolin (34%) were used most often. Sixty per cent (6/16) of patients who d eveloped 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 d ays (RR 4.0 (1.3-11.9)); presence of ventriculostomy (RR 3.4 (1.0-10.7)); C SF 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. Patient s found to be at greater risk for infection at our institution included dur ation of ICPM greater than 5 days, use of ventricular catheter, CSF leak, c oncurrent systemic infection, or serial ICPM.