title: Do antibiotic-impregnated external ventriculostomy catheters have a low infection rate in clinical practice? A retrospective cohort study.
abstract: OBJECTIVE
  External ventriculostomy-related infection (VRI) of cerebrospinal fluid (CSF) is a source of significant morbidity and mortality. In previous trials, antibiotic-impregnated ventricular catheters have been associated with lower incidence of CSF infections. We undertook this retrospective observational study to evaluate whether the introduction of antibiotic-impregnated external ventricular drains (EVDs) in 2004 has decreased VRI in our neurosurgical unit.
  
  
  METHODS
  One hundred and fifteen patients underwent insertion of EVDs from January 2000 to March 2008. Data were collected for 99 patients with a total of 146 EVD insertions. The parameters studied were age, gender, ASA score, seniority of the surgeon, significant medical history, presence of trauma, concurrent surgeries, revisional surgery, use of peri-operative systemic antibiotic, use of antibiotic-impregnated external ventricular catheter, tunnelling of the catheter, duration of drainage and VRIs.
  
  
  RESULTS
  Eleven patients developed new VRI (12%). Analysis comparing infection incidence for various co-morbidities shows that systemic sepsis was associated with higher infection rates (p = 0.037). Revisional surgery (p = 0.036) and longer duration of catheterization (p = 0.001) were also found to be associated with VRI. The Standard catheters and the antibiotic-impregnated catheters had similar infection rates. The antibiotic-impregnated catheters tended to be infection-free for longer but these differences were not statistically significant. The duration of catheterization was significantly higher for the antibiotic-impregnated catheter group. In both groups, the majority of infections were caused by Gram-positive bacteria.
  
  
  CONCLUSIONS
  Our study demonstrates that there was no statistically significant difference in the infection rates for the Standard and antibiotic-impregnated external ventriculostomy catheters. The duration of catheterization was significantly higher for the Antibiotic-impregnated catheter group. The antibiotic-impregnated catheter infections tended to occur later as compared with the Standard catheter group.
authors.affiliation: a Department of Neurosurgery , Western General Hospital , Edinburgh , UK ;
authors.forename: H
authors.initials: H
authors.lastname: Shekhar
authors.affiliation: b Department of Neurosurgery , James Cook University Hospital , Middlesbrough , UK.
authors.forename: P
authors.initials: P
authors.lastname: Kalsi
authors.affiliation: b Department of Neurosurgery , James Cook University Hospital , Middlesbrough , UK.
authors.forename: S
authors.initials: S
authors.lastname: Dambatta
authors.affiliation: b Department of Neurosurgery , James Cook University Hospital , Middlesbrough , UK.
authors.forename: R
authors.initials: R
authors.lastname: Strachan
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D015331:Cohort Studies; D004322:Drainage / Q000009:adverse effects; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000188:drug therapy* / Q000453:epidemiology*; D014696:Ventriculostomy / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents
keywords: antibiotic prophylaxis; cerebrospinal fluid drainage; risk factors for infection; ventriculitis