The impact of silver nanoparticle-coated and antibiotic-impregnated external ventricular drainage catheters on the risk of infections: a clinical comparison of 95 patients.
BACKGROUND
Infection, i.e. meningitis or ventriculitis, is a major complication of external ventricular drainage (EVD). In order to prevent this complication rifampin-impregnated and clindamycin-impregnated silicone catheters and EVDs impregnated with nanoparticles of silver and an insoluble silver salt have been developed. Sparse data are published concerning the efficacy of these catheters in reducing bacterial colonization.


METHODS
Between July 2003 and June 2006, 95 patients (age range 12-84 years, mean 53.6 years) underwent implantation of an EVD catheter for CSF diversion for several indications. All surgeries were performed in a standardized way at a single medical center. We used standard polyurethane catheters in 32 patients, Codman Bactiseal silicone catheters in 31 patients, and Spiegelberg Silverline catheters in 32 patients. Samples of the cerebrospinal fluid (CSF) were taken at the time of implantation, every 10 days and at the time of removal. The samples were microbiologically analyzed.


RESULTS
In 32 standard catheters we saw infections in 5 patients (15.6%). By contrast, 2 of the 31 patients with a Bactiseal catheter (6.5%) and 3 with a Silverline catheter (9.4%) developed an infection.


CONCLUSIONS
Rifampin-impregnated and clindamycin-impregnated EVDs as well as silver-impregnated EVDs decreased the infection rate. Randomized studies are needed to assess the advantage of these catheters compared with standard polyurethane catheters.
Department of Neurosurgery, Unfallkrankenhaus Berlin, Berlin, Germany.
Johannes
J
Lemcke
Felix
F
Depner
Ullrich
U
Meier
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D002408:Catheters, Indwelling; D002648:Child; D005260:Female; D006801:Humans; D017053:Infection Control; D007239:Infections / Q000209:etiology; D008297:Male; D053768:Metal Nanoparticles; D008875:Middle Aged; D012189:Retrospective Studies; D012834:Silver; D018754:Ventricular Dysfunction / Q000601:surgery; D055815:Young Adult
D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D012834:Silver