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Pre-emptive intrathecal vancomycin therapy reduces external ventricular drain infection: a single centre
Richard Z Fu1, Durria R Anwar1, James T Laban1
1a Department of Neurosurgery , Atkinson Morley Wing, St. George's Hospital , London , UK.
British Journal of Neurosurgery
|September 15, 2016
Summary
Pre-emptive intrathecal vancomycin (ITV) with standard external ventricular drain (EVD) catheters significantly reduces infection rates. This approach offers an effective alternative to specialized bactericidal catheters for neurosurgical patients.
Area of Science:
- Neurosurgery
- Infectious Disease
- Pharmacology
Background:
- External ventricular drain (EVD) placement is crucial for managing neurosurgical conditions.
- EVD-related infections pose a significant risk of morbidity and mortality.
- Novel bactericidal catheters are emerging, but cost and availability may be limiting.
Purpose of the Study:
- To evaluate the efficacy of pre-emptive intrathecal vancomycin (ITV) in reducing EVD-related infections.
- To compare infection rates between standard catheters with ITV and standard catheters alone.
- To determine if ITV is a viable alternative to bactericidal catheters.
Main Methods:
- Retrospective study of 262 EVD cases between 2010 and 2012.
- Comparison of infection rates in patients who received daily 10mg ITV versus those who did not.
- Infection defined by CDC guidelines (clinical suspicion, CSF analysis, or leucocytosis).
Main Results:
- The infection rate was significantly lower in the ITV group (2.7%) compared to the control group (11.9%) (p<.01).
- No vancomycin-resistant infections were observed in either group.
- The study included 111 patients managed with pre-emptive ITV.
Conclusions:
- Pre-emptive intrathecal vancomycin is associated with a substantial reduction in EVD infection rates.
- This strategy provides an effective and potentially more accessible alternative to bactericidal catheters.
- ITV demonstrates a favorable safety profile with no observed resistance.
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