title: Efficacy of silver nanoparticles-impregnated external ventricular drain catheters in patients with acute occlusive hydrocephalus.
abstract: 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.
authors.affiliation: Department of Neurology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria. peter.lackner@i-med.ac.at
authors.forename: Peter
authors.initials: P
authors.lastname: Lackner
authors.forename: Ronny
authors.initials: R
authors.lastname: Beer
authors.forename: Gregor
authors.initials: G
authors.lastname: Broessner
authors.forename: Raimund
authors.initials: R
authors.lastname: Helbok
authors.forename: Klaus
authors.initials: K
authors.lastname: Galiano
authors.forename: Claudia
authors.initials: C
authors.lastname: Pleifer
authors.forename: Bettina
authors.initials: B
authors.lastname: Pfausler
authors.forename: Christian
authors.initials: C
authors.lastname: Brenneis
authors.forename: Christian
authors.initials: C
authors.lastname: Huck
authors.forename: Klaus
authors.initials: K
authors.lastname: Engelhardt
authors.forename: Alois A
authors.initials: AA
authors.lastname: Obwegeser
authors.forename: Erich
authors.initials: E
authors.lastname: Schmutzhard
mesh_terms: 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
chemical_list: D012834:Silver