CSF Antibiotic Prophylaxis for Neurosurgical Patients with Ventriculostomy: a Randomised Study

Poon, Wai Sang; Ng, S. Thomas; Wai, S.

doi:10.1007/978-3-7091-6475-4_43

Cited by 66 publications

(69 citation statements)

References 6 publications

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“…While there is some data suggesting that PSA prevents VRIs seen with conventional EVDs, 3,14,17 there are no data to suggest that PSA provides additional clinical or microbiological benefit in combination with ac-EVDs. There are several risks associated with prolonged antibiotic exposure including development of antibiotic resistance, adverse effects of the antibiotics such as antibiotic-associated diarrhea, and Clostridium difficile infection.…”

Section: Discussionmentioning

confidence: 99%

“…One has been to use prophylactic antibiotics either at the time of EVD insertion, during the first 24 hours postinsertion, or in a prolonged systemic fashion (thus, PSA) while the EVD is in place. Evidence to support PSA is limited by the scarcity of adequately powered randomized controlled trials 14,19 and conflicting results. 5,11 As a result, there is no consistent practice regarding use of systemic antibiotics with EVDs and preference is largely based on tradition and training.…”

mentioning

confidence: 99%

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Rates and determinants of ventriculostomy-related infections during a hospital transition to use of antibiotic-coated external ventricular drains

Wright

Young

Brickman

et al. 2013

FOC

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Object The authors evaluated the rates of ventriculostomy-related infections (VRIs) after antibiotic-coated extraventricular drains (ac-EVDs) were introduced as the standard of care. Methods A retrospective chart review was conducted of adult patients admitted to NewYork-Presbyterian Hospital neurological intensive care unit in whom an EVD was placed between February 2007 and November 2009, excluding individuals receiving EVDs due to an infection of a primary device. Three time periods were defined depending on type of EVD in use: Period 1, conventional EVDs; Period 2, either ac-EVDs or conventional EVDs; and Period 3, ac-EVDs. Definite/probable VRIs that occurred during the 3 periods were evaluated and established as determinants of VRIs by using a Cox proportional hazards model. Prolonged systemic antibiotics were given for the duration of EVD placement in each of the 3 periods per institutional policy. Results Data from 141 individuals were evaluated; mean patient age was 53.8 ± 17.2 years and 54% were female. There were 2 definite and 19 probable VRIs. The incidence of definite/probable VRI (per 1000 person-catheter days) decreased from Period 1 to 3 (24.5, 16.2, and 4.4 in Periods 1, 2, and 3, respectively; p < 0.0001). Patients with VRIs were more likely to be female than male (23.7% vs 3.1%, p < 0.003) and have had an EVD in place for a longer duration, although there was no significant difference among the 3 periods (7.9 ± 6.7 [Period 1], 8.1 ± 7.1 [Period 2], and 8.6 ± 5.8 [Period 3] mean days; p = 0.87, ANOVA). Analysis of effect modification in a stepwise model showed that period, age, and age and female interaction were significant predictors of VRIs. The period was the strongest predictor of VRI (p = 0.0075). After adjustment for age and age and sex interaction, the survival rate was 53% at the end of Period 2 and 91% at the end of Period 3. Conclusions Rates of VRIs have decreased with the addition of ac-EVDs to the routine use of prolonged systemic antibiotics at the authors' institution.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Rates and determinants of ventriculostomy-related infections during a hospital transition to use of antibiotic-coated external ventricular drains

Wright

Young

Brickman

et al. 2013

FOC

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“…Bei der Anlage von externen Ventrikelkathetern wird von der Mehrzahl der praktizierenden Neurochirurgen eine Antibiotikaprophylaxe durchgeführt [22,63]. Eine Cochrane-Analyse randomisierter und quasi-randomisierter Studien zeigte einen Vorteil einer über 24 Stunden nach dem Eingriff gegebenen i.v.-Antibiotikaprophylaxe in Bezug auf Shunt-assoziierte Infektionen.…”

Section: Bezug Zu Anderen Empfehlungenunclassified

Anforderungen an die Hygiene bei Punktionen und Injektionen

2012

Krankenhaus-Hygiene + Infektionsverhütung

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“…Another study found that the prolonged use of ampicillin/sulbactam and aztreonam resulted in a lower infection rate compared with a single dose of perioperative ampicillin/sulbactam. However the former was associated with infections caused by resistant organisms such as methicillinresistant Staphylococcus aureus, and gram-negative organisms such as Pseudomonas or Klebsiella (Poon, et al, 1998). The role of prolonged systemic antibiotics and the best regimens are yet to be defined.…”

Section: Prophylactic Antibioticsmentioning

confidence: 99%