Efficacy of silver nanoparticles-impregnated external ventricular drain catheters in patients with acute occlusive hydrocephalus.
BACKGROUND
Catheter-associated infection of cerebrospinal fluid (CSF) is a potentially life-threatening complication of external ventricular drainage (EVD). The purpose of this pilot study was to address the efficacy of silver-impregnated EVD catheters in neurological and neurosurgical patients requiring external CSF drainage due to acute occlusive hydrocephalus.


METHODS
Nineteen consecutive patients were enrolled in the treatment arm of the study and data were prospectively recorded for these patients. The control group consisted of 20 patients for whom data were retrospectively assessed. CSF samples were drawn at least three times a week and routine bacterial cultures and CSF analyses were done according to standard protocols. The primary endpoint of the study was the occurrence of catheter-associated ventriculitis (CAV) proven by positive CSF culture. Secondary endpoints were bacterial colonization of the catheter tip and CSF pleocytosis.


RESULTS
In 20 control patients, 5 CAVs were microbiologically diagnosed. In contrast, no positive CSF cultures were found in the treatment group. This difference was statistically significant (P < 0.05). All CAVs occurred later than day 10 after catheter placement. Colonization of the catheter tip was found in 6 patients in the control group and in 5 patients in the treatment group (not significant).


CONCLUSIONS
This pilot study indicates that EVD catheters impregnated with silver nanoparticles might be a new option for preventing CAV in neurocritical care patients, and therefore evaluation in a large prospective randomized study is warranted.
Lackner
Peter
P
Department of Neurology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria. peter.lackner@i-med.ac.at
Beer
Ronny
R
Broessner
Gregor
G
Helbok
Raimund
R
Galiano
Klaus
K
Pleifer
Claudia
C
Pfausler
Bettina
B
Brenneis
Christian
C
Huck
Christian
C
Engelhardt
Klaus
K
Obwegeser
Alois A
AA
Schmutzhard
Erich
E
D000208:Acute Disease; D000368:Aged; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000382:microbiology; D003422:Critical Care; D004660:Encephalitis / Q000134:cerebrospinal fluid / Q000175:diagnosis; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000134:cerebrospinal fluid / Q000601:surgery*; D008297:Male; D053768:Metal Nanoparticles; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000134:cerebrospinal fluid / Q000175:diagnosis*; D012834:Silver; D014696:Ventriculostomy / Q000009:adverse effects* / Q000295:instrumentation
D012834:Silver