No additional protection against ventriculitis with prolonged systemic antibiotic prophylaxis for patients treated with antibiotic-coated external ventricular drains

Abstract

Object External ventricular drains (EVDs) are commonly used for CSF diversion but pose a risk of ventriculitis, with rates varying in frequency from 2% to 45%. Results of studies examining the utility of prolonged systemic antibiotic therapy for the prevention of EVD-related infection have been contradictory, and no study to date has examined whether this approach confers additional benefit in preventing ventriculitis when used in conjunction with antibiotic-coated EVDs (ac-EVDs). Methods A prospective performance analysis was conducted over 4 years to examine the impact of discontinuing systemic antibiotic prophylaxis after insertion of an ac-EVD on rates of catheter-related ventriculitis. Ventriculitis and other nosocomial infections were ascertained by a qualified infection disease nurse using definitions based on published standards from the Centers for Disease Control and Prevention, comparing the period when patients received systemic antibiotic therapy for the duration of EVD treatment (Period 1) compared with only for the peri-insertion period (Period 2). Costs were analyzed and compared across the 2 time periods Results Over the 4-year study period, 866 patients were treated with ac-EVDs for a total of 7016 catheter days. There were 8 cases of ventriculitis, for an overall incidence of 0.92%. Rates of ventriculitis did not differ significantly between Period 1 and Period 2 (1.1% vs 0.4%, p = 0.22). The rate of nosocomial infections, however, was significantly higher in Period 1 (2.0% vs 0.0% in Period 2, p = 0.026). Cost savings of $162,516 were realized in Period 2 due to decreased drug costs and savings associated with the reduction in nosocomial infections. Conclusions Prolonged systemic antibiotic therapy following placement of ac-EVDs does not seem to reduce the incidence of catheter-related ventriculitis, and was associated with a higher rate of nosocomial infections and increased cost.

Antibiotic prophylaxis for subdural and subgaleal drains

“…22 Both of these complications impact not just a single patient receiving PPSAs, but also all patients in the hospital because antibiotic use affects the flora to which all patients are exposed. 3,19 Because antibiotic use is associated with the risk of nosocomial infections and growth of resistant bacteria, 5,9,10,19,20 the CDC is exploring approaches to improve monitoring and reporting of inpatient antimicrobial use. 11 The Joint Commission monitors the use of prophylactic antibiotics and rates of discontinuation after 24 hours for a number of surgical procedures, but neurosurgical procedures are not among those tracked at this time.…”

2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis*

“…In light of these findings and based on the availability of an efficacious alternative (ie, antimicrobial-impregnated catheters; see below), the use of prophylactic prolonged systemic antimicrobials for prevention of infection in patients with external ventricular drains is not recommended, although prolonged use does remain the practice in some centers. In a recent study in patients with antimicrobial-impregnated external ventricular drains who also received prolonged systemic antimicrobial therapy, the addition of prolonged systemic therapy did not reduce the incidence of catheter-related ventriculitis but was associated with a higher rate of nosocomial infections (bloodstream infections and ventilator-associated pneumonia) and increased cost [173].…”

Prevención y tratamiento de las infecciones del sitio operatorio en neurocirugía. Estado del arte

“…De igual manera, la evidencia aún no es concluyente sobre el uso de catéteres impregnados y profilaxis sistémica prolongada conjunta (38,39) . Igualmente, frente al uso de catéteres impregnados de iones de plata, los estudios revisados han encontrado una reducción en las infecciones del sitio operatorio de forma significativa.…”