title: Impact of a standardized protocol and antibiotic-impregnated catheters on ventriculostomy infection rates in cerebrovascular patients.
abstract: BACKGROUND
  Ventriculostomy infections create significant morbidity. To reduce infection rates, a standardized evidence-based catheter insertion protocol was implemented. A prospective observational study analyzed the effects of this protocol alone and with antibiotic-impregnated ventriculostomy catheters.
  
  
  OBJECTIVE
  To compare infection rates after implementing a standardized protocol for ventriculostomy catheter insertion with and without the use of antibiotic-impregnated catheters.
  
  
  METHODS
  Between 2003 and 2008, 1961 ventriculostomies and infections were documented. A ventriculostomy infection was defined as 2 positive CSF cultures from ventriculostomy catheters with a concurrent increase in cerebrospinal fluid white blood cell count. A baseline (preprotocol) infection rate was established (period 1). Infection rates were monitored after adoption of the standardized protocol (period 2), institution of antibiotic-impregnated catheter A (period 3), discontinuation of antibiotic-impregnated catheter A (period 4), and institution of antibiotic-impregnated catheter B (period 5).
  
  
  RESULTS
  The baseline infection rate (period 1) was 6.7% (22/327 devices). Standardized protocol (period 2) implementation did not change the infection rate (8.2%; 23/281 devices). Introduction of catheter A (period 3) reduced infections to 1.0% (2/195 devices, P=.0005). Because of technical difficulties, this catheter was discontinued (period 4), resulting in an increase in infection rate (7.6%; 12/157 devices). Catheter B (period 5) significantly decreased infections to 0.9% (9 of 1001 devices, P=.0001). The Staphylococcus infection rate for periods 1, 2, and 4 was 6.1% (47/765) compared with 0.2% (1/577) during use of antibiotic-impregnated catheters (periods 3 and 5).
  
  
  CONCLUSIONS
  The use of antibiotic-impregnated catheters resulted in a significant reduction of ventriculostomy infections and is recommended in the adult neurosurgical population.
authors.affiliation: Department of Neurosurgery, Jefferson Medical College, and Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA. James.Harrop@jefferson.edu
authors.forename: James S
authors.initials: JS
authors.lastname: Harrop
authors.forename: Ashwini D
authors.initials: AD
authors.lastname: Sharan
authors.forename: John
authors.initials: J
authors.lastname: Ratliff
authors.forename: Srini
authors.initials: S
authors.lastname: Prasad
authors.forename: Pascal
authors.initials: P
authors.lastname: Jabbour
authors.forename: James J
authors.initials: JJ
authors.lastname: Evans
authors.forename: Erol
authors.initials: E
authors.lastname: Veznedaroglu
authors.forename: David W
authors.initials: DW
authors.lastname: Andrews
authors.forename: Mitchell
authors.initials: M
authors.lastname: Maltenfort
authors.forename: Kenneth
authors.initials: K
authors.lastname: Liebman
authors.forename: Phyllis
authors.initials: P
authors.lastname: Flomenberg
authors.forename: Bevin
authors.initials: B
authors.lastname: Sell
authors.forename: Amy S
authors.initials: AS
authors.lastname: Baranoski
authors.forename: Claudette
authors.initials: C
authors.lastname: Fonshell
authors.forename: David
authors.initials: D
authors.lastname: Reiter
authors.forename: Robert H
authors.initials: RH
authors.lastname: Rosenwasser
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002408:Catheters, Indwelling / Q000009:adverse effects* / Q000382:microbiology; D004866:Equipment Contamination / Q000517:prevention & control; D006801:Humans; D013530:Surgical Wound Infection / Q000188:drug therapy* / Q000503:physiopathology / Q000517:prevention & control*; D016896:Treatment Outcome; D014696:Ventriculostomy / Q000009:adverse effects* / Q000295:instrumentation*
chemical_list: D000900:Anti-Bacterial Agents