Antimicrobial-impregnated and -coated shunt catheters for prevention of infections in patients with hydrocephalus: a systematic review and meta-analysis

Abstract

OBJECT The aim of this study was to evaluate the effectiveness of antimicrobial-impregnated and -coated shunt catheters (antimicrobial catheters) in reducing the risk of infection in patients undergoing CSF shunting or ventricular drainage. METHODS The PubMed and Scopus databases were searched. Catheter implantation was classified as either shunting (mainly ventriculoperitoneal shunting) or ventricular drainage (mainly external [EVD]). Studies evaluating antibioticimpregnated catheters (AICs), silver-coated catheters (SCCs), and hydrogel-coated catheters (HCCs) were included. A random effects model meta-analysis was performed. RESULTS Thirty-six studies (7 randomized and 29 nonrandomized, 16,796 procedures) were included. The majority of data derive from studies on the effectiveness of AICs, followed by studies on the effectiveness of SCCs. Statistical heterogeneity was observed in several analyses. Antimicrobial shunt catheters (AICs, SCCs) were associated with lower risk for CSF catheter-associated infections than conventional catheters (CCs) (RR 0.44, 95% CI 0.35-0.56). Fewer infections developed in the patients treated with antimicrobial catheters regardless of randomization, number of participating centers, funding, shunting or ventricular drainage, definition of infections, de novo implantation, and rate of infections in the study. There was no difference regarding gram-positive bacteria, all staphylococci, coagulase-negative streptococci, and Staphylococcus aureus, when analyzed separately. On the contrary, the risk for methicillin-resistant S. aureus (MRSA, RR 2.64, 95% CI 1.26-5.51), nonstaphylococcal (RR 1.75, 95% CI 1.22-2.52), and gram-negative bacterial (RR 2.13, 95% CI 1.33-3.43) infections increased with antimicrobial shunt catheters. CONCLUSIONS Based on data mainly from nonrandomized studies, AICs and SCCs reduce the risk for infection in patients undergoing CSF shunting. Future studies should evaluate the higher risk for MRSA and gram-negative infections. Additional trials are needed to investigate the comparative effectiveness of the different types of antimicrobial catheters.

Delayed Manifestation of Shunt Nephritis: A Case Report and Review of the Literature

“…If a shunt is still necessary, VP shunts appear to be more preferable to VA or VJ shunts (see Table 7). The use of antibiotic-coated shunts and perioperative antibiotic prophylaxis may play a role in the prevention of shunt infection [79, 80]. …”

Primary ventriculoperitoneal shunting outcomes: a multicentre clinical audit for shunt infection and its risk factors

“…35,36 There exists a growing body of evidence in support of antibioticimpregnated ventricular catheters and they are gradually replacing conventional plain silicone catheters in daily practice with considerable cost savings. [37][38][39][40] There are also accompanying concerns about the development of antibiotic-resistant microorganisms and a recent meta-analysis has elucidated the higher risk of Gram-negative and MRSA shunt infections. 38 In this series, only 12 patients received antibiotic-impregnated catheters during the study period so it is difficult to draw any conclusion about their effectiveness.…”

A new Hydrocephalus Clinical Research Network protocol to reduce cerebrospinal fluid shunt infection

“…They have been the subject of a recent meta-analysis suggesting a reduced infection rate with their use. 8 The cost of care among patients treated with AICs has been reported to be lower. 4 In these data, the patients receiving AICs were compared with patients who did not receive them.…”