Reduction in external ventricular drain infection rate. Impact of a minimal handling protocol and antibiotic-impregnated catheters

Abstract

Minimal handling protocols constitute an essential strategy in the reduction of external ventricular drain-related infections. Besides that, the use of antibiotic-impregnated catheters may reduce infection-related hospital costs.

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

“…The reduction in VRIs to 4.3% after introduction of ac-EVDs is similar to the rates seen in other retrospective and prospective studies of ac-EVDs use, where infection rates were decreased to 0.9%-5% per EVD. 3,[6][7][8]13,15,16,18 However, studies differ in terms of how they define a VRI and also by the presence of prolonged antibiotic prophylaxis, making direct comparisons with our study difficult. Zabramski et al, 20 for example, reported results from a 6-center randomized clinical trial in which minocycline and rifampin ac-EVDs were compared with conventional EVDs, and almost all patients received PSA throughout the EVD placement period.…”

“…Other studies have also used a positive CSF culture to define VRI, but they vary in their sampling frame, from systematic CSF surveillance 2,7,8,18 to sampling only when there are clinical indications such as fever or leukocytosis. 3,15,16 Among published observational studies, the largest was conducted by Harrop et al, 8 in which 1961 ventriculostomies were observed over 6 years during 5 different periods of VRI control. Rates of VRI were lower in both periods during which ac-EVDs were used (0.9%-1.0%) than in periods when a conventional EVD was used (6.7%-8.2%).…”

Impact of antibiotic- and silver-impregnated external ventricular drains on the risk of infections: A systematic review and meta-analysis

“…A random model was used because of moderate heterogeneity (c 2 ¼ 3.14; P ¼ .21; I 2 ¼ 36%), and a pooled analysis of these RCTs showed no significant difference between the 2 groups (RR, 0.36; 95% CI, 0.11-1.15; P ¼ .09) (Fig 5A). Two observational studies were performed in children, 18,26 and the pooled data showed no significant difference (RR, 0.23; 95% CI, 0.03-2.08; P ¼ . 19).…”

“…The characteristics of the included studies are summarized in Table 1 and Table 2. 16,[18][19][20][21][22][23][24][25][26][27][28][29][30] Ten studies compared AI-EVD catheters with plain EVD catheters, of which 3 were RCTs. Five studies compared SI-EVD catheters with plain EVD catheters, but only 1 study was an RCT.…”

Antibiotic Impregnated External Ventricular Drains: Meta and Cost Analysis

“…A similar study examining the effects of a standard insertion protocol, both with and without the use of impregnated catheters, was published by Rivero-Garvia et al (28). There were three groups in this study: group 1 constituted a control cohort, group 2 followed the implementation of the standard insertion protocol, and finally clindamycin + rifampin AI-EVDs were introduced in group 3.…”