Introduction Previous prospective study in our unit had shown that the use of dual antibiotic prophylaxis in patients with external ventricular drain was associated with decreased incidence of cerebrospinal fluid infection but complicated with opportunistic extracranial infection. In recent years, cerebrospinal fluid shunt catheters impregnated with antimicrobial agents have become available. Theoretically, these catheters provide antibiotic prophylaxis locally without the associated complications of systemic opportunistic infection.
Methods We carried out a prospective randomized, controlled clinical trial in a regional neurosurgical center in Hong Kong. We recruited patients admitted for emergency neurosurgical operation after informed consent was obtained from next-of-kin. Eligible patients were randomized to receive an antibiotic-impregnated ventricular catheter or plain ventricular catheter Dual prophylactic antibiotic coverage was given to the patients randomized for plain ventricular catheter only. Patients who received antibiotic impregnanted catheters were not treated with systematic prophylactic antibiotics. Here we present the analysis of 110 patients, recruited over a 2-year period, to receive antibiotic-impregnanted ventricular catheters versus non-impregnated ventricular cathethers with prophylactic antibiotic coverage.
Findings Fifty-two patients were randomized to antibiotic-impregnated ventricular catheter with no systemic antibiotic prophylaxis (Group A) and 58 patients were randomized to plain ventricular catheters with prophylactic dual antibiotics (Group B). There was no ventriculostomy-related infection in either groups of patients. There was also no statistical significant difference in incidences of extracranial infections between the two groups, p=0.617. Conclusions In this analysis, antibiotic-impregnation of ventricular catheters was as effective as systemic antibiotics in the prevention of ventriculostomy infections, with the potential advantage of avoiding the systemic side-effects of prophylactic antibiotics.
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Alleyne CH, Hassan M, Zabramski JM (2000) The efficacy and cost of prophylactic and periprocedural antibiotics in patients with external ventricular drains. Neurosurgery 47:1124–1129
Bayston R, Lambert E (1997) Duration of protective activities of cerebrospinal fluid infection shunt catheters impregnated with antimicrobial agents to prevent bacterial catheter-related infection. J Neurosurg 87:247–251
Gaskin PR, St John MA, Cave CT, Clarke H, Bayston R, Levett PN (1994) Cerebrospinal fluid shunt infection due to corynebac-terium xerosis. J Infect 28:323–325
Holloway KL, Barnes T, Choi S, Bullock R, Marshall LF, Eisenberg HM, Jane JA, Ward JD, Young HF, Marmarou A (1996) Ventricu-lostomy infections: the effects of monitoring duration and catheter exchange in 584 patients. J Neurosurg 85:419–426
Mayhall CG, Archer NH, Lamb VA, Spadora AC, Baggett JW, Ward JD, Narayan RK (1984) Ventriculostomy-related infections: a prospective epidemiological study. N Engl J Med 310:553–559
Paramore CG, Turner DA (1994) Relative risks of ventriculostomy infection and morbidity. Acta Neurochir (Wien) 127:79–84
Pattavilakom A, KotasnasD,Korman TM, XenosC,DanksA(2006) Duration of in vivo antimicrobial activity of antibiotic-impregnated cerebrospinal fluid catheters. Neurosurgery 58:930–935
Poon WS, Ng S, Wai S (1998) CSF antibiotic prophylaxis for neurosurgical patients with ventriculostomy: a randomized study. Acta Neurochir Suppl (Wien) 71:146–148
Rebuck JA, Murry KR, Rhoney DH, Michael DB, Coplin WM (2000) Infection related to intracranial pressure monitors in adults: analysis of risk factors and antibiotic prophylaxis. J Neurol Neurosurg Psychiatry 69(3):381–389
Rosner MJ, Becker DP (1976) ICP monitoring: complications and associated factors. Clin Neurosurg 23:494–519
Rossi S, Buzzi F, Paparella A, Mainini P, Stocchetti N (1998) Complications and safety associated with ICP monitoring: a study of 542 patients. Acta Neurochir Suppl (Wien) 71:91–93
Winfield JA, Rosenthal P, Kanter RK, Casella G (1993) Duration of intracranial pressure monitoring does not predict daily risk of infective complications. Neurosurgery 33:424–431
Wong GK, Poon WS, Wai S, Yu LM, Lyon D, Lam JM (2002) Failure of regular external ventricular drain exchange to reduce cerebrospinal fluid infection: result of a randomized controlled trial. J Neurol Neurosurg Psychiatry 73:759–761
Zabramski JM, Whiting D, Darouiche RO, Horner TG, Olson J, Robertson C, Hamilton JA (2003) Efficacy of antimicrobial-impregnated external ventricular drain catheters: a prospective, randomized, controlled trial. J Neurosurg 98:725–730
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Wong, G.K.C., Poon, W.S., Ng, S.C.P., Ip, M. (2008). The impact of ventricular catheter impregnated with antimicrobial agents on infections in patients with ventricular catheter: interim report. In: Steiger, H.J. (eds) Acta Neurochirurgica Supplements. Acta Neurochirurgica Supplementum, vol 102. Springer, Vienna. https://doi.org/10.1007/978-3-211-85578-2_11
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