Infection Rates in Standard vs. Hydrogel Coated Ventricular Catheters

Abstract

Background:Infection related to external ventricular drain (EVD) use is a common neurosurgical complication. Modified catheters with a hydrophilic surface may impede bacterial adherence and thereby reduce catheter related cerebrospinal fluid (CSF) infection.Methods:A prospective randomized clinical trial compared the occurrence of CSF infection related to use of either standard silastic or hydrogel coated EVD catheters (Bioglide®, Medtronic). Enrolment was available to all adult neurosurgery patients undergoing placement of a first EVD, at three university centers. The catheters were presoaked in a low concentration of bacitracin solution for 5-10 minutes prior to insertion. Bacterial infection was defined by heavy growth in a single CSF sample or light / medium growth in two consecutive samples. A secondary analysis was also conducted for “probable” CSF infection, including patients started on antibiotics after light / medium growth in a single CSF sample. Statistical analyses included Kaplan-Meier survival curve estimates accompanied by Log Rank and Breslow tests.Results:There were 158 randomized patients available to assess for EVD related infection of CSF. The two study groups had similar clinical characteristics including average duration of EVD use (8±4 days). Definite CSF infection occurred in seven and probable infection in another six (8% total). Infection incidence rose steadily from day 2 (1%) to day 11 (11%). There was no difference of daily occurrence of EVD infection between the two catheter types.Conclusion:Infection remains a common hazard in the use of EVD, and we found no reduction of infection using the hydrogel-coated catheters when presoaked in low concentration bacitracin solution.

Strategies to Decrease the Risk of Ventricular Catheter Infections: A Review of the Evidence

“…Chemiluminescence demonstrated that HCCs significantly reduced adhesion of S. epidermidis. A Canadian group conducted a prospective randomized clinical trial to compare the occurrence of CSF infection with use of either standard silastic or hydrogel coated EVD catheters [36]. The authors studied 158 adult neurosurgery patients at three university centers who were undergoing placement of a first EVD.…”

Hydrogel-coated ventricular catheters for high-risk patients receiving ventricular peritoneum shunt

“…Our study has found a significant incidence of VPS-related CSF infections with coincidence of previous researches. [30–33] According to our experience, the infection rates in normal patients are much lower but can still cause serious consequences if infection occurs. Because the catheter is not the organic part of the body, the infection is more likely to occur compared with regular surgery.…”

“…Several studies have found that it may contribute to a reduced infection rate [29–32] whereas others have reported little benefits. [33–35] According to our assumption, the infecting bacteria enter the intracranial system at the point of catheter insertion and develop at a favorable catheter spot with little immunological intervention within the central nerve system. Nevertheless, the shunt devices can absorb antibiotics during the presoaking period and lower the shunt infection rate which is supported by various recent reports.…”

External Ventricular Drain Infections

“…The findings were controversial depending on the coating material used. One RCT did not show any benefit with the use of hydrogel-coated catheters presoaked in bacitracin solution (Kaufmann, et al, 2004). Silver-coated catheters were first used in central venous line with equivocal results (Bach, et al, 1999;Kalfon, et al, 2007).…”