title: Prevention of ventriculostomy-related infections with prophylactic antibiotics and antibiotic-coated external ventricular drains: a systematic review.
abstract: BACKGROUND
  Ventriculostomy-related infection (VRI) is a severe complication of external ventricular drain use, occurring in 5% to 23% of patients. Preventive measures for VRI include prolonged prophylactic systemic antibiotics (PSAs) and an antibiotic-coated external ventricular drains (ac-EVDs).
  
  
  OBJECTIVE
  We performed a systematic review of all studies evaluating PSAs and ac-EVD for VRI prevention through July 2010.
  
  
  METHODS
  Two reviewers independently assessed eligibility and evaluated study quality based on pre-established criteria. Observational studies and randomized clinical trials (RCTs) that fulfilled inclusion criteria were included in the meta-analysis.
  
  
  RESULTS
  Three RCTs and 7 observational studies met our inclusion criteria and were included in the analysis. The type of antibiotics and VRI definitions varied among these studies. Pooled analysis showed a protective effect of PSAs and ac-EVDs for VRI (risk ratio: 0.32; 95% CI: 0.18-0.56). Results showed moderate heterogeneity (I(2) = 53%) explained by the difference in quality among the studies and the inclusion of 1 large positive cohort study. The effect of PSAs and ac-EVDs was unrelated to the type of study (RCT or observational, P for interaction = .55), the route of antibiotic administration (PSAs or ac-EVDs, P = .13), or the quality of the studies (suboptimal vs good/excellent, P = .55).
  
  
  CONCLUSIONS
  RCTs and observational-derived evidence support the use of PSAs throughout the duration of external ventricular drainage; similarly, the use of ac-EVDs to prevent VRI seems to be beneficial. Available data are heterogeneous and of suboptimal quality. Further research is needed to confirm the findings of this meta-analysis. There are not sufficient data to compare the protective effect of ac-EVDs and PSAs.
authors.affiliation: Department of Neurological Surgery, Columbia University Medical Center, New York, New York 10032, USA. adam.sonabend@gmail.com
authors.forename: Adam M
authors.initials: AM
authors.lastname: Sonabend
authors.forename: Yoel
authors.initials: Y
authors.lastname: Korenfeld
authors.forename: Celina
authors.initials: C
authors.lastname: Crisman
authors.forename: Neeraj
authors.initials: N
authors.lastname: Badjatia
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Mayer
authors.forename: E Sander
authors.initials: ES
authors.lastname: Connolly
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects / Q000295:instrumentation; D004322:Drainage / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control*; D014696:Ventriculostomy / Q000009:adverse effects* / Q000295:instrumentation
chemical_list: D000900:Anti-Bacterial Agents