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Antimicrobial prophylaxis for external ventricular drains in pediatric neurosurgical patients
Amanda P Ifeachor1, Kristen R Nichols, Jennifer L Morris
1Department of Pharmacy, Roudebush Veterans Affairs Medical Center, Indianapolis, IN, USA, anpete2@gmail.com.
Insights
This study found no external ventricular drain (EVD) infections in pediatric neurosurgery patients, regardless of antibiotic prophylaxis duration. Further research is needed to confirm if prolonged antibiotic use offers benefits.
Area of Science:
- Neurosurgery
- Infectious Disease
- Pharmacology
Background:
- Antibiotic prophylaxis for external ventricular drains (EVDs) is common in pediatric neurosurgery.
- Varied strategies exist for antibiotic use, including perioperative and prolonged courses.
- The incidence of EVD-related infections across different prophylaxis strategies requires investigation.
Purpose of the Study:
- To describe antibiotic use for EVD surgical prophylaxis in pediatric neurosurgery.
- To determine the incidence of EVD-related infections based on antimicrobial prophylaxis strategies.
Main Methods:
- Retrospective chart review of pediatric patients (<18 years) undergoing EVD insertion (2008-2012).
- Comparison of patients receiving perioperative antibiotics versus those with prolonged antibiotic use.
- Primary endpoint: incidence of EVD-related infection; statistical analysis using chi-square and Mann Whitney U tests.
Main Results:
- 88 EVD insertions were analyzed; 27 received perioperative antibiotics, 61 received prolonged use.
- No statistically significant differences in baseline characteristics or antibiotic choices between groups.
- No central nervous system infections were identified in either group, precluding statistical evaluation of the primary objective.
Conclusions:
- No EVD-related infections were observed in the study population.
- The study was underpowered to statistically evaluate the benefit of prolonged antibiotic prophylaxis.
- A multi-center prospective study is recommended to determine the efficacy of extended antibiotic use beyond the perioperative period.
Background:
Our goal was to describe the use of antibiotics for surgical prophylaxis of external ventricular drains (EVDs) in a pediatric neurosurgical population and determine the incidence of EVD-related infections among different antimicrobial prophylaxis strategies.
Main Outcome Measures:
This retrospective chart review included patients up to 18 years old who underwent EVD insertion at either of two tertiary care academic hospitals in the same health system between August 1, 2008, and July 31, 2012. Patients were included if they received at least one dose of antibiotics before EVD insertion. Patients who received only perioperative antibiotics were compared with those who also received antibiotics after this period. The primary endpoint was incidence of EVD-related infection. Descriptive statistics were used to summarize baseline characteristics and compare antibiotic regimens between groups. Pearson's chi square and Mann Whitney U tests compared nonparametric data.
Results:
A total of 182 EVD insertions were documented, and 88 included in the study. Of these 88, 27 were associated only with perioperative doses of antibiotics, and 61 with prolonged antibiotic use. Baseline characteristics and antibiotic choices were similar between the groups. At least 55 (63%) catheters were antibiotic-impregnated, but types of catheters couldn't be compared between groups due to insufficient data. No central nervous system infections were identified in either group, so the primary objective could not be evaluated statistically.
Conclusion:
No infections were identified in any study subjects during EVD treatment. An adequately powered, multi-center prospective study should be performed to determine if prolonged use of antibiotics beyond the perioperative period is of benefit.
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