Comparison of two antibiotic-impregnated ventricular catheters: a prospective sequential series trial.
BACKGROUND
External ventricular drains (EVDs) are valuable adjuncts in the management of neurosurgical patients but are associated with a significant risk of cerebrospinal fluid (CSF) infection (range, 0% to 27%); a review of 23 studies reported a mean of 8.8%.


OBJECTIVE
To compare the efficacy of 2 different antibiotic-impregnated EVD catheters in preventing CSF infections.


METHODS
Patients were prospectively enrolled in an Institutional Review Board-approved study. During alternating 3-month periods, all patients received either a minocycline/rifampin-impregnated (M/R) ventricular catheter or a clindamycin/rifampin-impregnated (C/R) EVD catheter. CSF cultures were collected at the time of insertion and twice weekly. Positive cultures were defined a priori as growth of the same bacteria on 2 media (eg, blood agar and broth) or 2 cultures of the same bacteria on 1 medium (eg, broth).


RESULTS
Altogether, 129 patients (mean age, 58.4 years; 55 male) received 65 C/R catheters and 64 M/R catheters. The most common indications for EVD placement were aneurysmal subarachnoid hemorrhage (48.1%), spontaneous intraparenchymal hemorrhage (13.2%), and tumor (11.6%). The mean duration of ventriculostomy drainage was 11.8 and 12.7 days in the C/R and M/R groups, respectively. No positive CSF cultures were identified in either cohort.


CONCLUSIONS
The use of antibiotic-impregnated catheters was associated with an extremely low risk of CSF infection compared with the reported mean of nearly 9% for standard EVD catheters. Infection rates for both C/R and M/R EVD catheters were zero. These results support the use of antibiotic-impregnated EVD catheters in routine clinical practice.
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Adib A
AA
Abla
Joseph M
JM
Zabramski
Heidi K
HK
Jahnke
David
D
Fusco
Peter
P
Nakaji
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002408:Catheters, Indwelling / Q000382:microbiology; D002494:Central Nervous System Infections / Q000517:prevention & control*; D002557:Cerebrospinal Fluid Shunts / Q000379:methods; D002981:Clindamycin / Q000008:administration & dosage*; D004338:Drug Combinations; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000008:administration & dosage*; D012293:Rifampin / Q000008:administration & dosage*; D014696:Ventriculostomy / Q000009:adverse effects; D055815:Young Adult
D000900:Anti-Bacterial Agents; D004338:Drug Combinations; D002981:Clindamycin; D008911:Minocycline; D012293:Rifampin