Assessment of the in vivo formation of biofilm on external ventricular drainages

  • P. RamírezEmail author
  • M. Gordón
  • A. Soriano
  • S. Gil-Perotin
  • V. Marti
  • E. M. Gonzalez-Barbera
  • M. T. Sanchez-Aguilar
  • J. A. Simal
  • J. Bonastre


Biofilm formation on external ventricular drainages (EVDs) has been postulated as the main pathogenic mechanism for EVD-associated ventriculitis. However, biofilm on EVDs has never been systematically studied and the in vivo effect of antibiotic-impregnated EVDs on biofilm has not been assessed. The aim of this study was to measure the prevalence of biofilm formation on EVDs and to analyze the influence of antibiotic-impregnated EVD on the risk of biofilm formation and ventriculitis. Consecutive patients with EVDs were included in the study. Surveillance cerebrospinal fluid (CSF) cultures were performed twice a week. Withdrawn EVDs were cultured using standard bacteriologic techniques and examined under a scanning electron microscope. We collected 32 EVDs, 18 of which (56 %) were antibiotic-impregnated EVDs. Biofilm was present on 24 EVDs (75 %), ventriculitis was diagnosed in 6 patients (19 %), and colonization occurred in 12 patients (38 %). All cases of ventriculitis were due to Gram-negative bacteria. Biofilm was more frequent on EVDs originating from patients with ventriculitis or bacterial colonization. Impregnated EVDs did not avoid ventriculitis or colonization, but biofilm development on these devices depended on the time from insertion and varied from 67 % for those used for <7 days to 88 % for those used for ≥7 days (p = 0.094). In conclusion, biofilm is a common phenomenon on EVDs. Currently available impregnated EVDs could not avoid ventriculitis due to multidrug-resistant Gram-negative bacteria, but a trend of delayment of biofilm development was observed.


Rifampicin Clindamycin Minocycline External Ventricular Drainage Acinetobacter Baumannii 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Beer R, Lackner P, Pfausler B, Schmutzhard E (2008) Nosocomial ventriculitis and meningitis in neurocritical care patients. J Neurol 255:1617–1624PubMedCrossRefGoogle Scholar
  2. 2.
    Braxton EE Jr, Ehrlich GD, Hall-Stoodley L et al (2005) Role of biofilms in neurosurgical device-related infections. Neurosurg Rev 28:249–255PubMedCrossRefGoogle Scholar
  3. 3.
    Fux CA, Quigley M, Worel AM et al (2006) Biofilm-related infections of cerebrospinal fluid shunts. Clin Microbiol Infect 12:331–337PubMedCrossRefGoogle Scholar
  4. 4.
    Lo CH, Spelman D, Bailey M, Cooper DJ, Rosenfeld JV, Brecknell JE (2007) External ventricular drain infections are independent of drain duration: an argument against elective revision. J Neurosurg 106:378–383PubMedCrossRefGoogle Scholar
  5. 5.
    Lozier AP, Sciacca RR, Romagnoli MF, Connolly ES Jr (2002) Ventriculostomy-related infections: a critical review of the literature. Neurosurgery 51:170–181PubMedCrossRefGoogle Scholar
  6. 6.
    Fichtner J, Güresir E, Seifert V, Raabe A (2010) Efficacy of silver-bearing external ventricular drainage catheters: a retrospective analysis. J Neurosurg 112:840–846PubMedCrossRefGoogle Scholar
  7. 7.
    Lackner P, Beer R, Broessner G et al (2008) Efficacy of silver nanoparticles-impregnated external ventricular drain catheters in patients with acute occlusive hydrocephalus. Neurocrit Care 8:360–365PubMedCrossRefGoogle Scholar
  8. 8.
    Harrop JS, Sharan AD, Ratliff J et al (2010) Impact of a standardized protocol and antibiotic-impregnated catheters on ventriculostomy infection rates in cerebrovascular patients. Neurosurgery 67:187–191PubMedCrossRefGoogle Scholar
  9. 9.
    Honda H, Jones JC, Craighead MC, Diringer MN, Dacey RG, Warren DK (2010) Reducing the incidence of intraventricular catheter-related ventriculitis in the neurology–neurosurgical intensive care unit at a tertiary care center in St Louis, Missouri: an 8-year follow-up study. Infect Control Hosp Epidemiol 31:1078–1081PubMedCrossRefGoogle Scholar
  10. 10.
    Wong GK, Ip M, Poon WS, Mak CW, Ng RY (2010) Antibiotics-impregnated ventricular catheter versus systemic antibiotics for prevention of nosocomial CSF and non-CSF infections: a prospective randomised clinical trial. J Neurol Neurosurg Psychiatry 81:1064–1067PubMedCrossRefGoogle Scholar
  11. 11.
    Zabramski JM, Whiting D, Darouiche RO et al (2003) Efficacy of antimicrobial-impregnated external ventricular drain catheters: a prospective, randomized, controlled trial. J Neurosurg 98:725–730PubMedCrossRefGoogle Scholar
  12. 12.
    Kockro RA, Hampl JA, Jansen B et al (2000) Use of scanning electron microscopy to investigate the prophylactic efficacy of rifampin-impregnated CSF shunt catheters. J Med Microbiol 49:441–450PubMedGoogle Scholar
  13. 13.
    Lyke KE, Obasanjo OO, Williams MA, O’Brien M, Chotani R, Perl TM (2001) Ventriculitis complicating use of intraventricular catheters in adult neurosurgical patients. Clin Infect Dis 33:2028–2033PubMedCrossRefGoogle Scholar
  14. 14.
    Bayston R, Lambert E (1997) Duration of protective activity of cerebrospinal fluid shunt catheters impregnated with antimicrobial agents to prevent bacterial catheter-related infection. J Neurosurg 87:247–251PubMedCrossRefGoogle Scholar
  15. 15.
    Parsek MR, Singh PK (2003) Bacterial biofilms: an emerging link to disease pathogenesis. Annu Rev Microbiol 57:677–701PubMedCrossRefGoogle Scholar
  16. 16.
    Raad I, Costerton W, Sabharwal U, Sacilowski M, Anaissie E, Bodey GP (1993) Ultrastructural analysis of indwelling vascular catheters: a quantitative relationship between luminal colonization and duration of placement. J Infect Dis 168:400–407PubMedCrossRefGoogle Scholar
  17. 17.
    Sottile FD, Marrie TJ, Prough DS et al (1986) Nosocomial pulmonary infection: possible etiologic significance of bacterial adhesion to endotracheal tubes. Crit Care Med 14:265–270PubMedCrossRefGoogle Scholar
  18. 18.
    Inglis TJ, Millar MR, Jones JG, Robinson DA (1989) Tracheal tube biofilm as a source of bacterial colonization of the lung. J Clin Microbiol 27:2014–2018PubMedGoogle Scholar
  19. 19.
    Passerini L, Lam K, Costerton JW, King EG (1992) Biofilms on indwelling vascular catheters. Crit Care Med 20:665–673PubMedCrossRefGoogle Scholar
  20. 20.
    Tambe SM, Sampath L, Modak SM (2001) In vitro evaluation of the risk of developing bacterial resistance to antiseptics and antibiotics used in medical devices. J Antimicrob Chemother 47:589–598PubMedCrossRefGoogle Scholar
  21. 21.
    Raad I, Reitzel R, Jiang Y, Chemaly RF, Dvorak T, Hachem R (2008) anti-adherence activity and antimicrobial durability of anti-infective-coated catheters against multidrug-resistant bacteria. J Antimicrob Chemother 62:746–750PubMedCrossRefGoogle Scholar
  22. 22.
    Crane DP, Gromov K, Li D et al (2009) Efficacy of colistin-impregnated beads to prevent multidrug-resistant A. baumannii implant-associated osteomyelitis. J Orthop Res 27(8):1008–1015PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • P. Ramírez
    • 1
    • 2
    Email author
  • M. Gordón
    • 1
  • A. Soriano
    • 3
  • S. Gil-Perotin
    • 1
  • V. Marti
    • 1
  • E. M. Gonzalez-Barbera
    • 4
  • M. T. Sanchez-Aguilar
    • 1
  • J. A. Simal
    • 5
  • J. Bonastre
    • 1
  1. 1.Department of Intensive Care MedicineHospital Universitari i Politècnic la FeValenciaSpain
  2. 2.Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028)Instituto de Salud Carlos IIIMadridSpain
  3. 3.Infectious MedicineHospital ClinicBarcelonaSpain
  4. 4.Department of MicrobiologyHospital Universitari i Politècnic la FeValenciaSpain
  5. 5.Department of NeurosurgeryHospital Universitari i Politècnic la FeValenciaSpain

Personalised recommendations