Efficacy of antimicrobial medicated ventricular catheters: a network meta-analysis with trial sequential analysis

Area of Science:

• Neurosurgery
• Infectious Diseases
• Medical Device Technology

Background:

• Ventricular catheter infections pose significant risks in neurosurgery.
• The comparative efficacy of antibiotic-medicated (AM), silver-medicated (SM), and non-medicated (NM) catheters for infection control is not well-established.
• Recent trials necessitate updated evidence synthesis.

Purpose of the Study:

• To quantitatively synthesize evidence on the infection rates associated with AM, SM, and NM ventricular catheters.
• To assess the need for further research using trial sequential analysis (TSA).
• To incorporate indirect evidence through network meta-analysis (NMA).

Main Methods:

• Systematic review and network meta-analysis (NMA) of randomized controlled trials (RCTs).
• Inclusion of trials comparing AM, SM, and NM ventricular shunts (VPS) or external ventricular drains (EVD).
• Trial sequential analysis (TSA) to evaluate the certainty of evidence and need for further trials.

Main Results:

• Antibiotic-medicated VPS demonstrated a significantly lower infection rate than non-medicated VPS (RR 0.44; 95% CI: 0.27-0.73).
• Trial sequential analysis indicated a need for further evidence regarding infection rates.
• Silver-medicated catheters were inferior to antibiotic-medicated ones and showed no significant difference compared to non-medicated catheters.
• Network meta-analysis for VPS showed antibiotic-medicated catheters were superior to both silver-medicated (RR 0.41, 95% CI: 0.22-0.75) and non-medicated (RR 0.42; 95% CI: 0.25-0.71) options.
• Antibiotic-medicated shunts did not significantly affect reoperation rates (RR 0.99; 95% CI:0.81-1.20).

Conclusions:

• Antibiotic-medicated ventricular catheters are effective in reducing infection rates compared to non-medicated options.
• Further research is warranted to confirm these findings definitively.
• Silver-medicated catheters do not offer a significant advantage over non-medicated ones and are inferior to antibiotic-medicated catheters for infection prevention.