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Reduction in external ventricular drain infection rate. Impact of a minimal handling protocol and antibiotic-impregnated catheters

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An Erratum to this article was published on 26 February 2011

Abstract

Introduction

Many strategies have been developed with the aim of reducing external ventricular drain-related infections. Antibiotic-impregnated catheters are one of them.

Material and methods

We report 648 cases of external ventricular drain from a total of 534 patients treated at the Virgen del Rocío Hospital between 1995 and 2006. Three subgroups were considered: group 1 included patients treated between 1995 and 2000, as well as a total of 190 external ventricular drains and 59 cases of infection (31.05%); group 2, with patients treated between 2000 and 2004 and managed with a minimal handling protocol, included 210 external ventricular drains and nine cases of infection (4.29%); and group 3, treated between 2004 and 2006, with 248 external ventricular drains and six cases of infection (2.41%). This latter subgroup included patients managed with a minimal handling protocol and antibiotic-impregnated catheters.

Results

Infection rate was 17% when non-antibiotic-impregnated catheters were employed and 2.41% when antibiotic-impregnated catheters were inserted (p < 0.001). This difference was statistically significant before and after the introduction of a minimal handling protocol, with percentages of 5.31% and 3.27%, respectively (p < 0.001; odds ratio 0.08; absolute risk reduction 27.26%). However, no statistically significant difference was observed in infection rate when the impact of a minimal handling protocol was considered: 4.29% when only the protocol was introduced and 2.41% when both the protocol and antibiotic-impregnated catheters were used (p > 0.05).

Conclusion

Minimal handling protocols constitute an essential strategy in the reduction of external ventricular drain-related infections. Besides that, the use of antibiotic-impregnated catheters may reduce infection-related hospital costs.

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Conflicts of interest

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Authors and Affiliations

  1. Department of Neurosurgery, Hospital Virgen del Rocío, C/Manuel Siurot s/n, 41013, Seville, Spain

    Mónica Rivero-Garvía, Javier Márquez-Rivas & Ana Belén Rueda-Torres

  2. Department of Infectious Diseases, Hospital Virgen del Rocío, C/Manuel Siurot s/n, 41013, Seville, Spain

    Manuel Enrique Jiménez-Mejías

  3. Deparment of Pediatric Infectious Disease, Hospital Virgen del Rocío, C/Manuel Siurot s/n, 41013, Seville, Spain

    Olaf Neth

Authors
  1. Mónica Rivero-Garvía
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  2. Javier Márquez-Rivas
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  3. Manuel Enrique Jiménez-Mejías
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  4. Olaf Neth
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  5. Ana Belén Rueda-Torres
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Correspondence to Mónica Rivero-Garvía.

Additional information

Comment

Riviero-Garcia et al. have analyzed their results about the rate of infection of external ventricular drainage (EVD) in a pediatric population. A historical comparison of the results is made between a first period where no special protocol was used compared with a prospective second period where a minimal handling protocol (MHP) plus one single dose of Vancomycin given at the time of the catheter insertion was applied and a third period where the use of antibiotic-impregnated catheter (AIC; rifampicin and clindamycin) is added to the MHP. Changing from the no protocol period to the MHP showed an important reduction of the rate of infection, and adding the AIC showed even better results. These findings are in accordance with reported recent studies about the prevention of CSF infections after EVD insertion. Although there is a drastic decrease of the rate of infection in the last group of patients who benefited from the MHP and AIC, the difference between the MHP and MHP plus AIC group is not statistically significant, thus relativizing the effect of AIC also already reported by others. Choux et al. emphasized in the 1990s the necessity to adhere to a strict protocol for the handling of shunts to reduce the rate of CSF infection. The results brought by the present study using a MHP for the insertion of an EVD confirm Choux et al. principles.

1. Choux M, Genitori L, Lang D, Lena G.

Shunt implantation: reducing the incidence of shunt infection.

J Neurosurg 1992 Dec; 77(6):875–80.

Benedict Rilliet

Geneva, Switzerland

An erratum to this article can be found at http://dx.doi.org/10.1007/s00701-011-0980-y

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Rivero-Garvía, M., Márquez-Rivas, J., Jiménez-Mejías, M.E. et al. Reduction in external ventricular drain infection rate. Impact of a minimal handling protocol and antibiotic-impregnated catheters. Acta Neurochir 153, 647–651 (2011). https://doi.org/10.1007/s00701-010-0905-1

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