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Updated: Jan 20, 2026
Expression, Purification, and Antimicrobial Activity of S100A12
Published on: May 13, 2017
Durability of antimicrobial activity of antibiotic-impregnated external ventricular drains: a prospective study
Roman Mounier1,2, Elodie Lang1, Anne Hulin3
1Department of Anesthesia and Surgical Intensive Care, Henri Mondor University Hospital Assitance Publique-Hôpitaux de Paris (APHP), University Paris-Est-Créteil (UPEC), Créteil, France.
Background:
Antibiotic-impregnated external ventricular drains (AI-EVDs) have a debated efficacy in clinical studies.
Objectives:
Our aim was to assess the durability of antimicrobial activity of AI-EVDs used in clinical settings.
Methods:
From April 2017 to January 2018, all consecutive AI-EVDs (Bactiseal™) inserted in adult patients were prospectively included. After removal, each AI-EVD was cultured and assessed for antimicrobial activity on both internal and external sides of AI-EVDs. Catheters were each challenged with a single Staphylococcus strain [MSSA, MRSA or methicillin-resistant Staphylococcus epidermidis (MRSE)]. MS was used to measure residual concentrations of rifampicin and clindamycin.
Results:
Sixty-five AI-EVDs were included (56 patients). Among these, 21 were challenged with MSSA, 23 with MRSA and 21 with MRSE. Five ventriculostomy-related colonizations (9%) and two ventriculostomy-related infections (4%) occurred. Staphylococcus was the main bacterium responsible for colonization (4/5). AI-EVD inhibition decreased significantly against MRSA and MRSE according to duration of catheterization (for external and internal sides, P < 0.02) and overall volume of CSF drained (P < 0.005 for both sides against MRSE, P < 0.005 for external side against MRSA), but not against MSSA. Clindamycin concentration was not correlated with duration of catheterization or CSF volume drained, but <20% of initial concentration was recovered even after 5 days of AI-EVD dwelling. Conversely, rifampicin concentration showed a rapid and significant decline correlated to duration and CSF volume (P < 0.001 and P = 0.03, respectively).
Conclusions:
Antimicrobial activity of AI-EVDs dropped quickly in vivo. Antimicrobial impregnation did not prevent AI-EVD colonization by susceptible strains in 9% of the cases.
Insights
Antibiotic-impregnated external ventricular drains (AI-EVDs) show reduced antimicrobial activity over time, failing to prevent colonization in 9% of cases. Their efficacy is debated due to rapid drug concentration decline in vivo.
Area of Science:
- Neuroscience
- Infectious Diseases
- Medical Devices
Background:
- The clinical efficacy of antibiotic-impregnated external ventricular drains (AI-EVDs) remains a subject of debate.
- Assessing the in vivo durability of antimicrobial activity is crucial for understanding AI-EVD performance.
Purpose of the Study:
- To evaluate the sustained antimicrobial effectiveness of AI-EVDs in a clinical setting.
- To determine the factors influencing the decline of antimicrobial activity over time.
Main Methods:
- Prospective inclusion of adult patients receiving AI-EVDs (Bactiseal™).
- Post-removal culture and antimicrobial activity assessment of AI-EVDs against Staphylococcus strains (MSSA, MRSA, MRSE).
- Measurement of residual rifampicin and clindamycin concentrations.
Main Results:
- Five cases (9%) of ventriculostomy-related colonization and two (4%) infections occurred, primarily by Staphylococcus.
- Antimicrobial activity against MRSA and MRSE significantly decreased with longer catheterization duration and higher CSF drainage volumes.
- Rifampicin concentration declined rapidly and significantly, while clindamycin levels dropped below 20% of initial concentration within 5 days.
Conclusions:
- The in vivo antimicrobial activity of AI-EVDs diminishes rapidly.
- Antimicrobial impregnation of EVDs did not consistently prevent colonization by susceptible bacterial strains.
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