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CNS infection in children with brain tumors: adding ventriculostomy to brain tumor resection increases risk more than 20-fold

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Abstract

Purpose

To investigate the risk of central nervous system (CNS) infections in children undergoing neurosurgery for brain tumors.

Methods

Single-center retrospective cohort study including all children with brain tumors undergoing neurosurgical treatment over an 11-year period.

Results

A total of 274 patients undergoing 733 neurosurgical procedures were included. Overall, 12.8% of patients were diagnosed with a CNS infection during their course of treatment. CNS infections were more frequent among children treated with CSF diversion (p < 0.001) and independently associated with low age (OR/y 0.9 (CI 95% 0.769–0.941), intraventricular (OR 2.8, CI 95% 1.2–6.5), and high-grade tumors (OR 2.7, CI 95% 1.1–6.5). The majority of CNS infections occurred within 30 days of surgery, resulting in a postoperative CNS infection rate of 5.3%. Postoperative CNS infections were significantly more frequent following adjunct EVD placement during tumor resection compared to a stand-alone craniotomy (30.4% vs. 1.5%, RR 20.6, CI 95% 5.7–72.2).

Conclusion

CNS infections affect at least 12% of children with brain tumors and are associated with age, tumor location, and grade. Adding EVD to tumor surgery increases the risk of postoperative CNS infection, and reconsidering routine adjunct EVD placement is therefore advocated.

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Availability of data and material

The datasets generated during and/or analyzed during the current study may be made available in the anonymized format on reasonable request.

References

  1. Helligsoe ASL, Kenborg L, Henriksen LT et al (2022) Incidence and survival of childhood central nervous system tumors in Denmark, 1997–2019. Cancer Med 11:245–256. https://doi.org/10.1002/cam4.4429

    Article  PubMed  Google Scholar 

  2. Kim KS (2010) Acute bacterial meningitis in infants and children. Lancet Infect Dis 10:32–42. https://doi.org/10.1016/S1473-3099(09)70306-8

    Article  CAS  PubMed  Google Scholar 

  3. Lanphear J, Sarnaik S (2014) Presenting symptoms of pediatric brain tumors diagnosed in the emergency department. Pediatr Emerg Care 30:77–80. https://doi.org/10.1097/PEC.0000000000000074

    Article  PubMed  Google Scholar 

  4. Wong T-T, Liang M-L, Chen H-H, Chang F-C (2011) Hydrocephalus with brain tumors in children. Childs Nerv Syst ChNS Off J Int Soc Pediatr Neurosurg 27:1723–1734. https://doi.org/10.1007/s00381-011-1523-9

    Article  Google Scholar 

  5. Humphreys H, Jenks P, Wilson J et al (2017) Surveillance of infection associated with external ventricular drains: proposed methodology and results from a pilot study. J Hosp Infect 95:154–160. https://doi.org/10.1016/j.jhin.2016.09.008

    Article  CAS  PubMed  Google Scholar 

  6. Tunkel AR, Hasbun R, Bhimraj A et al (2017) Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. Clin Infect Dis Off Publ Infect Dis Soc Am 64:e34–e65. https://doi.org/10.1093/cid/ciw861

    Article  CAS  Google Scholar 

  7. Lu P, Raynald null, Liu W et al (2019) risk factors of external ventricular drainage-related infections: a retrospective study of 147 pediatric post-tumor resection patients in a single center. Front Neurol 10:1243. https://doi.org/10.3389/fneur.2019.01243

    Article  PubMed  PubMed Central  Google Scholar 

  8. Kim J, Kim JH, Lee W et al (2022) Predictors of ventriculostomy-associated infections: a retrospective study of 243 patients. World Neurosurg 160:e40–e48. https://doi.org/10.1016/j.wneu.2021.12.085

    Article  PubMed  Google Scholar 

  9. Schrøder H, Rechnitzer C, Wehner PS et al (2016) Danish childhood cancer registry Clin Epidemiol 8:461–464. https://doi.org/10.2147/CLEP.S99508

    Article  Google Scholar 

  10. Ostrom QT, De Blank PM, Kruchko C et al (2014) Alex’s lemonade stand foundation infant and childhood primary brain and central nervous system tumors diagnosed in the United States in 2007–2011. Neuro-Oncol 16:x1–x35. https://doi.org/10.1093/neuonc/nou327

    Article  PubMed Central  Google Scholar 

  11. Foster MT, Hennigan D, Grayston R et al (2021) Reporting morbidity associated with pediatric brain tumor surgery: are the available scoring systems sufficient? J Neurosurg Pediatr 27:556–565. https://doi.org/10.3171/2020.9.PEDS20556

    Article  PubMed  Google Scholar 

  12. Lassen B, Helseth E, Egge A et al (2012) Surgical mortality and selected complications in 273 consecutive craniotomies for intracranial tumors in pediatric patients. Neurosurgery 70:936–943;discussion 943. https://doi.org/10.1227/NEU.0b013e31823bcc61

  13. Campbell E, Beez T, Todd L (2017) Prospective review of 30-day morbidity and mortality in a paediatric neurosurgical unit. Childs Nerv Syst ChNS Off J Int Soc Pediatr Neurosurg 33:483–489. https://doi.org/10.1007/s00381-017-3358-5

    Article  Google Scholar 

  14. Drake JM, Riva-Cambrin J, Jea A et al (2010) Prospective surveillance of complications in a pediatric neurosurgery unit. J Neurosurg Pediatr 5:544–548. https://doi.org/10.3171/2010.1.PEDS09305

    Article  PubMed  Google Scholar 

  15. Campioli CC, Challener D, Comba IY et al (2022) Overview and risk factors for postcraniotomy surgical site infection: a four-year experience. Antimicrob Steward Healthc Epidemiol 2:e14. https://doi.org/10.1017/ash.2021.258

    Article  Google Scholar 

  16. Sherrod BA, Arynchyna AA, Johnston JM et al (2017) Risk factors for surgical site infection following nonshunt pediatric neurosurgery: a review of 9296 procedures from a national database and comparison with a single-center experience. J Neurosurg Pediatr 19:407–420. https://doi.org/10.3171/2016.11.PEDS16454

    Article  PubMed  PubMed Central  Google Scholar 

  17. Jamjoom AAB, Joannides AJ, Poon MT-C et al (2018) Prospective, multicentre study of external ventricular drainage-related infections in the UK and Ireland. J Neurol Neurosurg Psychiatry 89:120–126. https://doi.org/10.1136/jnnp-2017-316415

    Article  PubMed  Google Scholar 

  18. Hagel S, Bruns T, Pletz MW et al (2014) External ventricular drain infections: risk factors and outcome. Interdiscip Perspect Infect Dis 2014:708531. https://doi.org/10.1155/2014/708531

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

He Zhang for aid in statistical analyses. Östen Jonsson for guidance.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, University Hospital Rigshospitalet, 2100, Copenhagen, Denmark

    Anna Boethun, Jane Skjøth-Rasmussen & Jon Foss-Skiftesvik

  2. Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, 2100, Copenhagen, Denmark

    Anna Boethun, Nadja Hawwa Vissing, René Mathiasen & Jon Foss-Skiftesvik

  3. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

    Jane Skjøth-Rasmussen

Authors
  1. Anna Boethun
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  2. Nadja Hawwa Vissing
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  4. Jane Skjøth-Rasmussen
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  5. Jon Foss-Skiftesvik
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Contributions

Study conceptualization: René Mathiasen, Jane Skjøth-Rasmussen, Nadja Hawwa Vissing. Data collection: Anna Boethun. Data analysis and drafting of manuscript: Anna Boethun, Jon Foss-Skiftesvik. All co-authors reviewed and approved the final manuscript.

Corresponding authors

Correspondence to Anna Boethun or Jon Foss-Skiftesvik.

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Ethics approval and consent to participate

This study was approved by the Danish Patient Safety Authority (31–1521-220). Individual patient consent was not required due to the nature of the study.

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The authors have no relevant financial or non-financial interests to disclose.

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Boethun, A., Vissing, N.H., Mathiasen, R. et al. CNS infection in children with brain tumors: adding ventriculostomy to brain tumor resection increases risk more than 20-fold. Childs Nerv Syst 39, 387–394 (2023). https://doi.org/10.1007/s00381-022-05799-8

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  • DOI: https://doi.org/10.1007/s00381-022-05799-8

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