193 INFECTIOUS COMPLICATIONS ARE NOT RELATED TO DURATION OF INTRACRANIAL PRESSURE MONITORING

Abstract

We retrospectively reviewed intracranial pressure (ICP) monitors to determine whether infectious complications occur most frequently at the time of monitor insertion, or increase with duration of monitoring. Seventy two ICP monitors in 65 children with acute brain injuries were reviewed. Monitoring was carried out for 7 days or longer in more than half the cases (range 1–28 days). Nine infections (positive monitor surveillance cultures) occurred on days 2–11. The risk of a subsequent infection rose from an initial 1.5 infections/100 subsequent monitor-days to a high of 1.9 infections/100 subsequent monitor-days on day 6, and progressively diminished after day 6. For monitors remaining in place and uninfected, the percent with a subsequent infection was highest in the first 2 days and diminished thereafter. If a distinction is made between monitor colonization (positive monitor surveillance culture, patient afebrile, no CSF pleocytosis) vs. patient infection (fever, CSF pleocytosis), only 8.3% of monitors overall, and only 4.9% of monitors in non-craniotomy patients caused infection. These observations suggest that introduction of infection occurs at the time of monitor insertion. Routine reinsertion of a new monitor might increase risk by re-exposing the patient to contamination at the time of insertion. An indwelling ICP monitor should be used as long as necessary with reinsertion of a new monitor only if a malfunction or positive surveillance culture occurs.

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