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.
Similar content being viewed by others
References
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.
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.
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.
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.
Beer R, Lackner P, Pfausler B, Schmutzhard E. Nosocomial ventriculitis and meningitis in neurocritical care patients. J Neurol. 2008;255(11):1617–24.
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.
Ortiz R, Lee K. Nosocomial infections in neurocritical care. Curr Neurol Neurosci Rep. 2006;6(6):525–30.
Lozier A, Sciacca R, Romagnoli M, Connolly E. Ventriculostomy-related infections: a critical review of the literature. Neurosurgery. 2002;51(1):170–81.
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.
Stenager E, Gerner-Smidt P, Kock-Jensen C. Ventriculostomy-related infections—an epidemiological study. Acta Neurochir (Wien). 1986;83(1–2):20–3.
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.
Schultz M, Moore K, Foote AW. Bacterial ventriculitis and duration of ventriculostomy catheter insertion. J Neurosci Nurs. 1993;25(3):158–64.
Sundbärg G, Nordström CH, Söderström S. Complications due to prolonged ventricular fluid pressure recording. Br J Neurosurg. 1988;2(4):485–95.
Smith RW, Alksne JF. Infections complicating the use of external ventriculostomy. J Neurosurg. 1976;44(5):567–70.
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.
Poon WS, Ng S, Wai S. CSF antibiotic prophylaxis for neurosurgical patients with ventriculostomy: a randomised study. Acta Neurochir Suppl. 1998;71:146–8.
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.
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.
Bayston R, Ashraf W, Fisher L. Prevention of infection in neurosurgery: role of “antimicrobial” catheters. J Hosp Infect. 2007;65(Suppl 2):39–42.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
McCarthy, P.J., Patil, S., Conrad, S.A. et al. International and Specialty Trends in the Use of Prophylactic Antibiotics to Prevent Infectious Complications after Insertion of External Ventricular Drainage Devices. Neurocrit Care 12, 220–224 (2010). https://doi.org/10.1007/s12028-009-9284-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12028-009-9284-y