Pre-emptive intrathecal vancomycin therapy reduces external ventricular drain infection: a single centre retrospective case-control study.
OBJECTIVE
External ventricular drain (EVD)-related infection is a significant source of morbidity in neurosurgical patients. Recently, there has been a drive to adopt new catheters with bactericidal properties to reduce infection rates. We propose that the use of standard catheters combined with pre-emptive intrathecal vancomycin (ITV) 10 mg daily provides an effective alternative.


METHODS
Retrospective study of all patients with EVDs between 2010 and 2012, comparing infection rates in those who did and did not receive pre-emptive ITV. All EVDs were of the standard silicon catheter type. CSF infection was defined, as per Centre for Disease Control (CDC) guidelines, as clinical suspicion ± positive CSF gram stain/culture or leucocytosis. Infection rates were compared using Pearson's chi-squared test.


RESULTS
262 EVDs were included in the study, of which 111 were managed with pre-emptive ITV. The infection rate was 2.7% in the vancomycin group and 11.9% in the control group (p<.01). There were no cases of vancomycin-resistant infection in either group.


CONCLUSIONS
The use of pre-emptive ITV is associated with a significantly lower EVD infection rate. This compares favourably with those reported in the literature for bactericidal catheters.
a Department of Neurosurgery , Atkinson Morley Wing, St. George's Hospital , London , UK.
Richard Z
RZ
Fu
a Department of Neurosurgery , Atkinson Morley Wing, St. George's Hospital , London , UK.
Durria R
DR
Anwar
a Department of Neurosurgery , Atkinson Morley Wing, St. George's Hospital , London , UK.
James T
JT
Laban
a Department of Neurosurgery , Atkinson Morley Wing, St. George's Hospital , London , UK.
Eleni C
EC
Maratos
a Department of Neurosurgery , Atkinson Morley Wing, St. George's Hospital , London , UK.
Pawanjit S
PS
Minhas
a Department of Neurosurgery , Atkinson Morley Wing, St. George's Hospital , London , UK.
Andrew J
AJ
Martin
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000191:economics / Q000379:methods*; D016022:Case-Control Studies; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D057785:Catheters; D002557:Cerebrospinal Fluid Shunts; D002648:Child; D002675:Child, Preschool; D017046:Cost Savings; D004322:Drainage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007223:Infant; D007278:Injections, Spinal; D007964:Leukocytosis / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014640:Vancomycin / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use*; D020713:Vancomycin Resistance; D014696:Ventriculostomy; D055815:Young Adult
D000900:Anti-Bacterial Agents; D014640:Vancomycin
External ventricular drains; cost-analysis; infection; pre-emptive intrathecal antibiotic therapy