Title

Comparison of two antibiotic-impregnated ventricular catheters: a prospective sequential series trial.

Department

Neurosurgery

Document Type

Article

Abstract

BACKGROUND: External ventricular drains (EVDs) are valuable adjuncts in the management of neurosurgical patients but are associated with a significant risk of cerebrospinal fluid (CSF) infection (range, 0% to 27%); a review of 23 studies reported a mean of 8.8%.

OBJECTIVE: To compare the efficacy of 2 different antibiotic-impregnated EVD catheters in preventing CSF infections.

METHODS: Patients were prospectively enrolled in an Institutional Review Board-approved study. During alternating 3-month periods, all patients received either a minocycline/rifampin-impregnated (M/R) ventricular catheter or a clindamycin/rifampin-impregnated (C/R) EVD catheter. CSF cultures were collected at the time of insertion and twice weekly. Positive cultures were defined a priori as growth of the same bacteria on 2 media (eg, blood agar and broth) or 2 cultures of the same bacteria on 1 medium (eg, broth).

RESULTS: Altogether, 129 patients (mean age, 58.4 years; 55 male) received 65 C/R catheters and 64 M/R catheters. The most common indications for EVD placement were aneurysmal subarachnoid hemorrhage (48.1%), spontaneous intraparenchymal hemorrhage (13.2%), and tumor (11.6%). The mean duration of ventriculostomy drainage was 11.8 and 12.7 days in the C/R and M/R groups, respectively. No positive CSF cultures were identified in either cohort.

CONCLUSIONS: The use of antibiotic-impregnated catheters was associated with an extremely low risk of CSF infection compared with the reported mean of nearly 9% for standard EVD catheters. Infection rates for both C/R and M/R EVD catheters were zero. These results support the use of antibiotic-impregnated EVD catheters in routine clinical practice.

Medical Subject Headings

Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Catheters, Indwelling; Central Nervous System Infections; Cerebrospinal Fluid Shunts; Clindamycin; Drug Combinations; Female; Humans; Male; Middle Aged; Minocycline; Rifampin; Ventriculostomy; Young Adult

Publication Date

2-1-2011

Publication Title

Neurosurgery

ISSN

1524-4040

Volume

68

Issue

2

First Page

437

Last Page

442

PubMed ID

21135715

Digital Object Identifier (DOI)

10.1227/NEU.0b013e3182039a14

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