Neurocritical Care

, Volume 12, Issue 2, pp 220–224 | Cite as

International and Specialty Trends in the Use of Prophylactic Antibiotics to Prevent Infectious Complications after Insertion of External Ventricular Drainage Devices

  • Paul J. McCarthy
  • Shashikant Patil
  • Steven A. Conrad
  • L. Keith Scott
Original Article
First Online:

Abstract

Background

External ventricular drains (EVD) are used as a method of diverting cerebral spinal fluid out of the cranium. After placement of these drains, it has been customary to initiate antibiotics to prevent drain-related infections. Prophylactic regimes include peri-operative and prolonged administration of antibiotics. Little evidence exists to support either regime. To determine current practices or to determine if an unintended consensus has developed, a survey was taken concerning antibiotic prophylaxis with EVD insertion.

Methods

E-mail survey from a membership database of the Neurocritical Care Society, a database of neurosurgeons maintained by the LSU Department of Neurosurgery and infectious diseases practitioners from a Department of Medicine database.

Results

There was an approximate 781 responses. Of the responders, 77% (599) were neurosurgeons, 10.5% (82) neurocritical care, 5.0% (41) intensivists, 6.5% (50) infectious diseases specialist, and 1% (9) others. The majority of responders (64%) have been in practice > 10 years. Most respondents from outside Europe recommended use of prophylactic antibiotics. Of those that did use antibiotics prophylaxis, the majority (56%) recommend use for the duration the catheter is in place. The exception is European responders used peri-operative prophylaxis most frequently. The majority of responders (78%) support a prospective trial to address this issue.

Conclusion

The use of antibiotics prophylaxis after EVD placement is disparate among specialties that deal with EVD placement and complications. There is no consistent practice pattern based on specialty, locale, and years of practice. The majority of all responders felt a prospective trial was warranted.

Keywords

External ventricular drains Ventriculitis Antibiotic prophylaxis Intracranial monitoring 
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References

  1. 1.
    Dasic D, Hanna SJ, Bojanic S, Kerr RS. External ventricular drain infection: the effect of a strict protocol on infection rates and a review of the literature. Br J Neurosurg. 2006;20(5):296–300.CrossRefPubMedGoogle Scholar
  2. 2.
    Schade RP, Schinkel J, Visser LG, Van Dijk JM, Voormolen JH, Kuijper EJ. Bacterial meningitis caused by the use of ventricular or lumbar cerebrospinal fluid catheters. J Neurosurg. 2005;102(2):229–34.CrossRefPubMedGoogle Scholar
  3. 3.
    Lucey MA, Myburgh JA. Antibiotic prophylaxis for external ventricular drains in neurosurgical patients: an audit of compliance with a clinical management protocol. Crit Care Resusc. 2003;5(3):182–5.PubMedGoogle Scholar
  4. 4.
    Korinek AM, Reina M, Boch AL, Rivera AO, De Bels D, Puybasset L. Prevention of external ventricular drain-related ventriculitis. Acta Neurochir (Wien). 2005;147(1):39–45.CrossRefGoogle Scholar
  5. 5.
    Beer R, Lackner P, Pfausler B, Schmutzhard E. Nosocomial ventriculitis and meningitis in neurocritical care patients. J Neurol. 2008;255(11):1617–24.CrossRefPubMedGoogle Scholar
  6. 6.
    Alleyne CHJ, Hassan M, Zabramski JM. The efficacy and cost of prophylactic and perioprocedural antibiotics in patients with external ventricular drains. Neurosurgery. 2000;47(5):1124–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Ortiz R, Lee K. Nosocomial infections in neurocritical care. Curr Neurol Neurosci Rep. 2006;6(6):525–30.CrossRefPubMedGoogle Scholar
  8. 8.
    Lozier A, Sciacca R, Romagnoli M, Connolly E. Ventriculostomy-related infections: a critical review of the literature. Neurosurgery. 2002;51(1):170–81.CrossRefPubMedGoogle Scholar
  9. 9.
    Mayhall CG, Archer NH, Lamb VA, Spadora AC, Baggett JW, Ward JD, et al. Ventriculostomy-related infections. A prospective epidemiologic study. N Engl J Med. 1984;310(9):553–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Stenager E, Gerner-Smidt P, Kock-Jensen C. Ventriculostomy-related infections—an epidemiological study. Acta Neurochir (Wien). 1986;83(1–2):20–3.CrossRefGoogle Scholar
  11. 11.
    Holloway KL, Barnes T, Choi S, Bullock R, Marshall LF, Eisenberg HM, et al. Ventriculostomy infections: the effect of monitoring duration and catheter exchange in 584 patients. J Neurosurg. 1996;85(3):419–24.CrossRefPubMedGoogle Scholar
  12. 12.
    Schultz M, Moore K, Foote AW. Bacterial ventriculitis and duration of ventriculostomy catheter insertion. J Neurosci Nurs. 1993;25(3):158–64.PubMedGoogle Scholar
  13. 13.
    Sundbärg G, Nordström CH, Söderström S. Complications due to prolonged ventricular fluid pressure recording. Br J Neurosurg. 1988;2(4):485–95.CrossRefPubMedGoogle Scholar
  14. 14.
    Smith RW, Alksne JF. Infections complicating the use of external ventriculostomy. J Neurosurg. 1976;44(5):567–70.CrossRefPubMedGoogle Scholar
  15. 15.
    Lyke KE, Obasanjo OO, Williams MA, O’Brien M, Chotani R, Perl TM. Ventriculitis complicating use of intraventricular catheters in adult neurosurgical patients. Clin Infect Dis. 2001;33(12):2028–33.CrossRefPubMedGoogle Scholar
  16. 16.
    Poon WS, Ng S, Wai S. CSF antibiotic prophylaxis for neurosurgical patients with ventriculostomy: a randomised study. Acta Neurochir Suppl. 1998;71:146–8.PubMedGoogle Scholar
  17. 17.
    Aucoin PJ, Kotilainen HR, Gantz NM, Davidson R, Kellogg P, Stone B. Intracranial pressure monitors epidemiologic study of risk factors and infections. Am J Med. 1986;80(3):369–76.CrossRefPubMedGoogle Scholar
  18. 18.
    Wong GK, Poon WS, Ng SC, Ip M. The impact of ventricular catheter impregnated with antimicrobial agents on infections in patients with ventricular catheter: interim report. Acta Neurochir Suppl. 2008;102:53–5.CrossRefPubMedGoogle Scholar
  19. 19.
    Bayston R, Ashraf W, Fisher L. Prevention of infection in neurosurgery: role of “antimicrobial” catheters. J Hosp Infect. 2007;65(Suppl 2):39–42.CrossRefPubMedGoogle Scholar

Copyright information

© Humana Press Inc. 2009

Authors and Affiliations

  • Paul J. McCarthy
    • 1
    • 2
  • Shashikant Patil
    • 1
  • Steven A. Conrad
    • 1
    • 2
  • L. Keith Scott
    • 1
    • 2
  1. 1.Department of NeurosurgeryLouisiana State University Health Sciences CenterShreveportUSA
  2. 2.Department of MedicineLouisiana State University Health Sciences CenterShreveportUSA

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