Reduction of ventriculostomy-associated CSF infection with antibiotic-impregnated catheters in pediatric patients: a single-institution study

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>External ventricular drains (EVDs) are commonly used in the neurosurgical population. However, very few pediatric neurosurgery studies are available regarding EVD-associated infection rates with antibiotic-impregnated EVD catheters. The authors previously published a large pediatric cohort study analyzing nonantibiotic-impregnated EVD catheters and risk factors associated with infections. In this study, they aimed to analyze the EVD-associated infection rate after implementation of antibiotic-impregnated EVD catheters.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>A retrospective observational cohort of pediatric patients (younger than 18 years of age) who underwent a burr hole for antibiotic-impregnated EVD placement and who were admitted to a quaternary care ICU between January 2011 and January 2019 were reviewed. The ventriculostomy-associated infection rate in patients with antibiotic-impregnated EVD catheters was compared to the authors’ historical control of patients with nonantibiotic-impregnated EVD catheters.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Two hundred twenty-nine patients with antibiotic-impregnated EVD catheters were identified. Neurological diagnostic categories included externalization of an existing shunt (externalized shunt) in 34 patients (14.9%); brain tumor (tumor) in 77 patients (33.6%); intracranial hemorrhage (ICH) in 27 patients (11.8%); traumatic brain injury (TBI) in 6 patients (2.6%); and 85 patients (37.1%) were captured in an “other” category. Two of 229 patients (0.9% of all patients) had CSF infections associated with EVD management, totaling an infection rate of 0.99 per 1000 catheter days. This is a significantly lower infection rate than was reported in the authors’ previously published analysis of the use of nonantibiotic-impregnated EVD catheters (0.9% vs 6%, p = 0.00128).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>In their large pediatric cohort, the authors demonstrated a significant decline in ventriculostomy-associated CSF infection rate after implementation of antibiotic-impregnated EVD catheters at their institution.</jats:p></jats:sec>

Healthcare-Associated Ventriculitis in Children during COVID-19 Pandemic: Clinical Characteristics and Outcome of a First Infection

“…The median duration of HAV after the procedure in patients with EVD was 7 days (IQR 3-9), similar to the findings in the large cohort reported by Topjian et al, with a median time to positive culture of 7 days (IQR 4.75, 9), but a lower rate of HAV of 6% [21]. The same authors later demonstrated a significant decline in the ventriculostomy-associated CSF infection rate after the implementation of antibiotic-impregnated EVD catheters at their institution (0.9% vs. 6%, p = 0.00128) [22]. One study with a small number of preterm, low-birth-weight infants with post-hemorrhagic hydrocephalus found an infection rate of 7.7% (1/13) per patient and 4% (1/25) per procedure, using an antibiotic-impregnated EVD for a longer catheterization period [23].…”

External ventricular drainage in pediatric patients: indications, management, and shunt conversion rates

“…Most published studies on pediatric EVD placement concerned EVD-related infections, reported to occur in up to 37% [ 32 ] and varying usually from 0.9 to 20% [ 16 – 18 , 27 , 32 – 37 ]. A major problem is the choice of criteria for definition of an EVD-related infection [ 12 , 18 , 27 , 31 , 32 , 34 , 37 – 41 ]. Most centers based on their experience suggest to use specific institutional guidelines for EVD management to reduce infection rates [ 16 – 18 , 27 , 32 – 36 , 42 ].…”

“…On the other hand, the possibility of a selection of more aggressive bacteria by using such catheters is still discussed [ 43 ]. Lang et al recently reported a further reduction in infection rates from 6 to 0.9% when using antimicrobial-impregnated catheters, placed in the OR combined with postoperative care on the ICU [ 34 ]. Nevertheless, it remained unclear whether or not the location for EVD placement is relevant.…”

Nano zinc oxide decorated latex drainage: A promising antibacterial material prevent retrograde infection associated with drainage

“…Domestic and foreign scholars have carried out a large number of studies on catheter-associated infection. Among them, Lang et al 27 used an antimicrobial-impregnated shunt catheter to make the drainage have antibacterial properties, which reduced the infection rate of CSF from 9% to 0.6%. 27 But the use of antibiotics brings with it the problem of drug resistance.…”

“…Among them, Lang et al 27 used an antimicrobial-impregnated shunt catheter to make the drainage have antibacterial properties, which reduced the infection rate of CSF from 9% to 0.6%. 27 But the use of antibiotics brings with it the problem of drug resistance. In addition, Lajcak et al 28 used silver-impregnated catheters to reduce the EVD infection rate significantly, 28 but the toxicity of silver is a problem that cannot be ignored.…”