Ahead of Print: A Simple Protocol to Prevent External Ventricular Drain Infections

Background: External ventricular drains (EVDs) are associated with high rates of infection, and EVD infections cause substantial morbidity and mortality.

Objective: We set out to determine whether introduction of an evidence-based EVD Infection Control protocol could reduce the rate of EVD infections.

Methods: This was a retrospective analysis of an EVD Infection Control protocol introduced in a tertiary care Neuro-ICU. We compared rates of cerebrospinal fluid (CSF) culture positivity and ventriculitis for the three years before and three years after the introduction of an evidence-based EVD Infection Control protocol. A total of 262 EVD placements were analyzed, with a total of 2,499 catheter-days.

Free Article: Infection Risk in Neurointervention and Cerebral Angiography

Background: The risk of infection with cerebral angiography and neurointerventional procedures has not been defined. Likewise, although the use of routine prophylactic antibiotics has been advocated by some neurointerventionalists, the utility of prophylactic antibiotics in this setting has not been determined.

Objective: To determine the rate of infection associated with neuroangiographic procedures in a clinical setting in which prophylactic antibiotics are not routinely given.

Methods: All cerebral angiograms and neurointerventional procedures done by a single neurointerventionalist over a recent 7-year period were retrospectively reviewed. Patients with infections directly attributable to the procedure were identified. A sample size calculation was done to determine the necessary size of a randomized, controlled trial aimed at determining whether prophylactic antibiotics can lower the rate of infection.

Ahead of Print: Infection Risk in Neurointervention and Cerebral Angiography

Background: The risk of infection with cerebral angiography and neurointerventional procedures has not been defined. Likewise, although the use of routine prophylactic antibiotics has been advocated by some neurointerventionalists, the utility of prophylactic antibiotics in this setting has not been determined.

Objective: To determine the rate of infection associated with neuroangiographic procedures in a clinical setting in which prophylactic antibiotics are not routinely given.

Methods: Retrospective review of all cerebral angiograms and neurointerventional procedures done by a single neurointerventionalist over a recent seven year period. Patients with infections directly attributable to the procedure were identified. A sample size calculation was done to determine the necessary size of a randomized controlled trial aimed at determining whether prophylactic antibiotics can lower the rate of infection.

Ahead of Print: Silver-Impregnated Line Vs EVD Randomized Trial

Background: Cerebrospinal fluid (CSF) infections associated with external ventricular drain (EVD) placement attract major consequences. Silver impregnation of catheters attempts to reduce infection.

Objective: To assess the efficacy of silver catheters against CSF infection.

Methods: We performed a randomized controlled trial involving two neurosurgical centers (June 2005 to September 2009). 356 patients requiring an EVD were assessed for eligibility; 325 patients were enrolled and randomized (167 plain, 158 silver). 278 patients were analyzed (140 plain, 138 silver). The primary outcome measure was CSF infection as defined by organisms seen on gram stain or isolated by culture. Secondary outcome measures included ventriculo-peritoneal (VP) shunting.

Ahead of Print: Intracerebral Abscess with ICP Monitor

Background and Importance: Intracranial pressure (ICP) monitoring is a mainstay in the management of traumatic brain injury. Large investigations have validated the safety and efficacy of ICP monitors in comatose patients. Clinically relevant infections are extremely rare and cerebral abscess has never been reported using the Camino device. We describe an exceptional case of a life-threatening intracerebral abscess from an intraparenchymal ICP monitor.

Clinical Presentation: A 35 week old child required 7 days of ICP monitoring following a fall from a two-story window. His hospital course was complicated by severe airway edema treated, in part, with high dose corticosteroid therapy for a total of 10 days. Two weeks later the patient acutely deteriorated due to a large intracerebral abscess under the previous ICP monitor site. Urgent craniotomy with evacuation of the abscess was performed on two separate occasions. Cultures grew methicillin-sensitive Staphylococcus aureus which was treated with long-term antibiotics. At 3-month follow-up the patient was meeting age-appropriate milestones without focal deficits.