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Published on: July 13, 2019
Do antibiotic-impregnated external ventriculostomy catheters have a low infection rate in clinical practice? A
H Shekhar1, P Kalsi2, S Dambatta2
1a Department of Neurosurgery , Western General Hospital , Edinburgh , UK ;
Objective:
External ventriculostomy-related infection (VRI) of cerebrospinal fluid (CSF) is a source of significant morbidity and mortality. In previous trials, antibiotic-impregnated ventricular catheters have been associated with lower incidence of CSF infections. We undertook this retrospective observational study to evaluate whether the introduction of antibiotic-impregnated external ventricular drains (EVDs) in 2004 has decreased VRI in our neurosurgical unit.
Method:
One hundred and fifteen patients underwent insertion of EVDs from January 2000 to March 2008. Data were collected for 99 patients with a total of 146 EVD insertions. The parameters studied were age, gender, ASA score, seniority of the surgeon, significant medical history, presence of trauma, concurrent surgeries, revisional surgery, use of peri-operative systemic antibiotic, use of antibiotic-impregnated external ventricular catheter, tunnelling of the catheter, duration of drainage and VRIs.
Results:
Eleven patients developed new VRI (12%). Analysis comparing infection incidence for various co-morbidities shows that systemic sepsis was associated with higher infection rates (p = 0.037). Revisional surgery (p = 0.036) and longer duration of catheterization (p = 0.001) were also found to be associated with VRI. The Standard catheters and the antibiotic-impregnated catheters had similar infection rates. The antibiotic-impregnated catheters tended to be infection-free for longer but these differences were not statistically significant. The duration of catheterization was significantly higher for the antibiotic-impregnated catheter group. In both groups, the majority of infections were caused by Gram-positive bacteria.
Conclusion:
Our study demonstrates that there was no statistically significant difference in the infection rates for the Standard and antibiotic-impregnated external ventriculostomy catheters. The duration of catheterization was significantly higher for the Antibiotic-impregnated catheter group. The antibiotic-impregnated catheter infections tended to occur later as compared with the Standard catheter group.
Insights
Antibiotic-impregnated external ventricular drains (EVDs) did not significantly reduce ventriculostomy-related infection (VRI) rates compared to standard catheters. However, these catheters were associated with longer drainage durations and infections occurred later.
Area of Science:
- Neurosurgery
- Infectious Disease
- Medical Devices
Background:
- External ventriculostomy-related infection (VRI) poses significant risks.
- Previous studies suggested antibiotic-impregnated catheters may lower infection rates.
Purpose of the Study:
- To evaluate the impact of introducing antibiotic-impregnated external ventricular drains (EVDs) on VRI incidence.
- To compare VRI rates between standard and antibiotic-impregnated EVDs.
Main Methods:
- Retrospective observational study of 99 patients with 146 EVD insertions.
- Data collected on patient factors, surgical details, and catheter type.
- Analysis of VRI incidence in relation to various parameters.
Main Results:
- No statistically significant difference in VRI rates between standard and antibiotic-impregnated catheters.
- Systemic sepsis, revisional surgery, and longer catheterization duration were associated with higher VRI.
- Antibiotic-impregnated catheters had longer duration of catheterization and infections tended to occur later.
Conclusions:
- Antibiotic-impregnated EVDs did not significantly decrease VRI rates in this neurosurgical unit.
- Longer catheterization duration was observed with antibiotic-impregnated catheters.
- Further research may be needed to optimize infection prevention strategies.
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