Introduction: External ventricular drains (EVDs) are essential in pediatric neurocritical care but carry a significant risk of infection. While guidelines exist, pediatric-specific recommendations to prevent EVD-related infections (EVDRIs) are limited and it remains unclear what practices are actually being utilized. This study aimed to characterize current infection prevention practices for EVDs among pediatric neurocritical care centers.
Methods: A conditional branching electronic survey that comprised of 7 to 21 questions was sent to the primary contact of 75 hospitals across North America belonging to the Pediatric Neurocritical Care Research Group. One answer per center was allowed and responses were collected electronically over a 12-week period. Survey responses were reported using percentages, and Fisher’s exact test was used to compare practices based on center EVD volume.
Results: Twenty-four of 75 centers (32%) responded. Most (83%) reported administering a periprocedural prophylactic antibiotic, universally cefazolin. Half continued prophylactic antibiotics while the EVD was in place, predominantly cefazolin, although specific regimens varied widely. A single center continued antibiotics after the EVD was removed. Impregnated catheters were used by half of the centers, with clindamycin/rifampin impregnated being the most common. Surveillance cerebral spinal fluid sampling was performed in 42% of centers, with variable intervals. Only 25% reported routine dressing changes, with the time interval between changes varying and chlorhexidine being the predominant disinfectant; another 25% reported not having a dressing in place. We could not identify any statistically significant differences in practice between centers based on center EVD volume. Thirty-eight percent reported no EVDRIs for the calendar year 2024 and 25% reported between 1-3.
Conclusions: According to our survey, pediatric institutions employ diverse strategies to prevent EVDRIs, reflecting a lack of consensus. We also identified inconsistent adherence to established guidelines across the surveyed centers. These findings are limited by reliance on self-reported data, but underscore the need for further investigation into pediatric-specific, evidence-based recommendations to standardize care in children with EVDs.
