title: Silver-impregnated external-ventricular-drain-related cerebrospinal fluid infections: a meta-analysis.
abstract: BACKGROUND
  Cerebrospinal fluid (CSF) infection is the primary complication associated with placement of an external ventricular drain (EVD). The use of silver-impregnated EVD catheters has become commonplace in many neurosurgical centres.
  
  
  OBJECTIVE
  To assess the effect of silver-impregnated EVD catheter usage on catheter-related CSF infections.
  
  
  METHODS
  A meta-analysis was performed by systematically searching Medline, Embase and the Cochrane Library. All randomized controlled trials (RCTs) and non-RCTs comparing silver-impregnated and plain EVD catheters were identified and analysed.
  
  
  RESULTS
  Six non-RCTs were included. The crude infection rate was 10.8% for plain catheters and 8.9% for silver-impregnated catheters [pooled odds ratio (OR) 0.71, 95% confidence interval (CI) 0.46-1.08; P = 0.11]. In a microbiological spectrum analysis, silver-impregnated catheters demonstrated a significantly lower rate of CSF infections caused by Gram-positive organisms (2.0% vs 6.7% in the silver-impregnated and plain catheter groups, respectively; pooled OR 0.27, 95% CI 0.11-0.63; P = 0.002).
  
  
  CONCLUSIONS
  The antimicrobial effects of silver-impregnated EVD catheters may be selective, and may need to be evaluated further in a prospective, controlled manner.
authors.affiliation: Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Manchester Academic Health Sciences Centre, Salford, UK; Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
authors.forename: R A
authors.initials: RA
authors.lastname: Atkinson
authors.affiliation: Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: Fikrey
authors.affiliation: Centre for Biostatistics, The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK.
authors.forename: A
authors.initials: A
authors.lastname: Vail
authors.affiliation: Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Manchester Academic Health Sciences Centre, Salford, UK; Vascular and Stroke Centre, Institute of Cardiovascular Sciences, The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK. Electronic address: hiren.patel@srft.nhs.uk.
authors.forename: H C
authors.initials: HC
authors.lastname: Patel
mesh_terms: D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000517:prevention & control; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002555:Cerebrospinal Fluid / Q000382:microbiology*; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects*; D004202:Disinfectants / Q000008:administration & dosage*; D004203:Disinfection / Q000379:methods; D004322:Drainage / Q000009:adverse effects*; D006801:Humans; D008581:Meningitis / Q000453:epidemiology / Q000517:prevention & control; D012834:Silver / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D004202:Disinfectants; D012834:Silver
keywords: Cerebrospinal fluid; External ventricular drain; Infection; Neurosurgery; Silver; Ventriculitis