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

Abstract

The use of antibiotic-coated external ventricular catheters has been controversial among practitioners; although several papers have documented decreased adherence of microbes to catheters treated with antibiotics, there is no universally accepted practice standard for the use of coated catheters for the prevention of clinical infection. In this paper, we review the in vivo and in vitro evidence for antibiotic-coated catheters.

Decreasing ventricular infections through the use of a ventriculostomy placement bundle: experience at a single institution

“…31,[39][40][41] Antimicrobial-impregnated catheters have been manufactured for a variety of applications and have been shown to be effective in preventing EVD-associated infections. 1,2,4,12,27,30,32,47,50,58 Current evidence suggests that antibiotic-impregnated catheters reduce the incidence of shunt infection. 1,11,15,24,32,39,40,47 Other factors thought to be important in preventing infection include tunneling of the ventricular catheter, proper skin preparation for surgery, strict adherence to aseptic technique, use of a closed ventricular drainage system, and meticulous sterile nursing care.…”

“…1,11,15,24,32,39,40,47 Other factors thought to be important in preventing infection include tunneling of the ventricular catheter, proper skin preparation for surgery, strict adherence to aseptic technique, use of a closed ventricular drainage system, and meticulous sterile nursing care. 2,4,8,12,21,29,33,42,43,58 The Institute of Health Care Improvement has defined so-called care bundles as a structured way of improving the processes of care and patient outcomes by using a small, straightforward set of practices that have been recommended to decrease a complication-in this case health care-associated infections-when performed collectively. 19,20,38 The objective of this quality improvement project was to study whether a ventriculostomy placement bundle, combining the aforementioned preventive factors, and implemented prospectively by a single institution with continuous feedback, would decrease the ventricular catheter-associated infection rate in our Neurointensive Care Unit.…”

Long subcutaneous tunnelling reduces infection rates in paediatric external ventricular drains

“…1) does not take into account the different operating protocols and infection definitions across the centres at which the procedures were carried out. As discussed, EVD-related infection is a multi-factorial problem [49] and it would be difficult to disregard all the compounding factors apart from the tunnelling length and the use of AICs that may influence the comparison with the other studies. This study was also conducted in the paediatric population, and comparing with adult studies may not offer a true comparison.…”

Establishment of an External Ventricular Drain Best Practice Guideline

“…Although the literature reports that the incidence of infections related to EVD insertion and maintenance is most commonly between 10% and 17%, rates as high as 45% have been reported (Babu, Patel, Marsh, & Wijdicks, 2012;Lozier, Sciacca, Romagnoli, & Connolly, 2002;Lyke et al, 2001;Zingale, Ippolito, Pappalardo, Chibbaro, & Amoroso, 1999). Despite high infection rates, many hospitals do not have strict protocols for EVD placement and maintenance nor do they track these infections with the same diligence as central-line catheter infections.…”