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Efficacy of antimicrobial medicated ventricular catheters: a network meta-analysis with trial sequential analysis

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Abstract

There is paucity of evidence regarding relative performance of antibiotic-medicated (AM), silver-medicated (SM) and non-medicated (NM) ventricular catheters in controlling infection rate. We aim to quantitatively synthesize the current evidence after addition of the three-armed British Antibiotic and Silver Impregnated Catheters for ventriculoperitoneal Shunts (BASICS) trial, understand the need for further evidence using trial sequential analysis (TSA) and incorporate the indirect evidence using network meta-analysis (NMA). Randomized controlled trials (RCTs) comparing AM, SM and NM ventriculoperitoneal shunt (VPS) or external ventricular drain (EVD) were included. Antibiotic-medicated VPS show a significantly lower infection rate as compared to non-medicated VPS (RR 0.44; 95% CI: 0.27–0.73; p = 0.001), however, TSA reveals need for further evidence. SM including both EVD as well as VPS were found to be inferior to AM while no significant difference was found in comparison to the NM catheters. In NMA for VPS, the AM were found to be significantly better than SM (RR 0.41, 95% CI: 0.22–0.75) as well as NM (RR 0.42; 95% CI: 0.25–0.71) with a SUCRA of 99.8% and a mean rank of 1. However, antibiotic medicated shunts did not show a statistically significant association with reoperation rate (RR 0.99; 95% CI:0.81–1.20; p = 0.9) with no further need for evidence as per TSA.

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Author notes

  1. Revanth Goda and Akshay Ganeshkumar have contributed equally to this manuscript.

Authors and Affiliations

  1. Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India

    Revanth Goda, Akshay Ganeshkumar, Varidh Katiyar, Ravi Sharma, Hitesh Kumar Gurjar, Roshan Sahu & Hitesh Inder Singh Rai

  2. Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India

    Aprajita Chaturvedi

  3. Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India

    Zainab Vora

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Contributions

Conception of idea- Ra.S., V.K., H.K.G

Conception and design of analysis- V.K., A.C.

Performed the analysis- V.K., A.G.

Collection of data- R.G., A.G., H.I.S.

Contribution of data, tools- H.K.G.

Writing the manuscript- R.G., A.G., Z.V., Ro.S., Ra.S., V.K., H.K.G.

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Correspondence to Hitesh Kumar Gurjar.

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Goda, R., Ganeshkumar, A., Katiyar, V. et al. Efficacy of antimicrobial medicated ventricular catheters: a network meta-analysis with trial sequential analysis. Neurosurg Rev 45, 91–102 (2022). https://doi.org/10.1007/s10143-021-01532-2

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