title: Comparison of infection rate with the use of antibiotic-impregnated vs standard extraventricular drainage devices: a prospective, randomized controlled trial.
abstract: BACKGROUND
  External ventricular drainage (EVD) catheters provide reliable and accurate means of monitoring intracranial pressure and alleviating elevated pressures via drainage of cerebrospinal fluid (CSF). CSF infections occur in approximately 9% of patients. Antibiotic-impregnated (AI) EVD catheters were developed with the goal of reducing the occurrence of EVD catheter-related CSF infections and their associated complications.
  
  
  OBJECTIVE
  To present an international, prospective, randomized, open-label trial to evaluate infection incidence of AI vs standard EVD catheters.
  
  
  METHODS
  Infection was defined as (1) proven infection, positive CSF culture and positive Gram stain or (2) suspected infection: (A) positive CSF culture with no organisms identified on initial Gram stain; (B) negative CSF culture with a gram-positive or -negative stain; (C) CSF leukocytosis with a white blood cell/red blood cell count >0.02.
  
  
  RESULTS
  Four hundred thirty-four patients underwent implantation of an EVD catheter. One hundred seventy-six patients in the AI-EVD cohort and 181 in the standard EVD catheter cohort were eligible for evaluation of infection. The 2 groups were similar in all clinical characteristics. Proven infection was documented in 9 (2.5%) patients (AI: 4 [2.3%] vs standard: 5 [2.8%], P = 1.0). Suspected infection was documented in 31 (17.6%) patients receiving AI and 37 (20.4%) patients receiving standard EVD catheters, P = .504. Duration of time to suspected infection was prolonged in the AI cohort (8.8 ± 6.1 days) compared with the standard EVD cohort (4.6 ± 4.2 days), P = .002.
  
  
  CONCLUSIONS
  AI-EVD catheters were associated with an extremely low rate of catheter-related infections. AI catheters were not associated with risk reduction in EVD infection compared to standard catheters. Use of AI-EVD catheters is a safe option for a wide variety of patients requiring CSF drainage and monitoring, but the efficacy of AI-EVD catheters was not supported in this trial.
authors.affiliation: Frenchay Hospital, Bristol, United Kingdom.
authors.forename: Ian
authors.initials: I
authors.lastname: Pople
authors.forename: Wai
authors.initials: W
authors.lastname: Poon
authors.forename: Richard
authors.initials: R
authors.lastname: Assaker
authors.forename: David
authors.initials: D
authors.lastname: Mathieu
authors.forename: Mark
authors.initials: M
authors.lastname: Iantosca
authors.forename: Ernest
authors.initials: E
authors.lastname: Wang
authors.forename: Li Wei
authors.initials: LW
authors.lastname: Zhang
authors.forename: Gilberto
authors.initials: G
authors.lastname: Leung
authors.forename: Paul
authors.initials: P
authors.lastname: Chumas
authors.forename: Philippe
authors.initials: P
authors.lastname: Menei
authors.forename: Laurent
authors.initials: L
authors.lastname: Beydon
authors.forename: Mark
authors.initials: M
authors.lastname: Hamilton
authors.forename: Ian
authors.initials: I
authors.lastname: Kamaly
authors.forename: Stephen
authors.initials: S
authors.lastname: Lewis
authors.forename: Wang
authors.initials: W
authors.lastname: Ning
authors.forename: J Thomas
authors.initials: JT
authors.lastname: Megerian
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: McGirt
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Murphy
authors.forename: Aileen
authors.initials: A
authors.lastname: Michael
authors.forename: Torstein
authors.initials: T
authors.lastname: Meling
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy / Q000209:etiology*; D055499:Catheter-Related Infections / Q000188:drug therapy / Q000209:etiology*; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D013997:Time Factors; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents