NEUROSURGERY Report

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Posts Tagged ‘Ventriculitis

Free Article: Prevention of Ventriculostomy-Related Infections With Prophylactic Antibiotics and Antibiotic-Coated External Ventricular Drains: A Systematic Review

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BACKGROUND: Ventriculostomy-related infection (VRI) is a severe complication of external ventricular drain use, occurring in 5% to 23% of patients. Preventive measures for VRI include prolonged prophylactic systemic antibiotics (PSAs) and an antibiotic-coated external ventricular drains (ac-EVDs).

OBJECTIVE: We performed a systematic review of all studies evaluating PSAs and ac-EVD for VRI prevention through July 2010.

METHODS: Two reviewers independently assessed eligibility and evaluated study quality based on pre-established criteria. Observational studies and randomized clinical trials (RCTs) that fulfilled inclusion criteria were included in the meta-analysis.

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Written by NEUROSURGERY® Editorial Office

April 5, 2011 at 9:40 AM

Editor Choice: Impact of a Standardized Protocol and Antibiotic-Impregnated Catheters on Ventriculostomy Infection Rates in Cerebrovascular Patients

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Harrop, James S. MD; Sharan, Ashwini D. MD; Ratliff, John MD; Prasad, Srini MD; Jabbour, Pascal MD; Evans, James J. MD; Veznedaroglu, Erol MD; Andrews, David W. MD; Maltenfort, Mitchell PhD; Liebman, Kenneth MD; Flomenberg, Phyllis MD; Sell, Bevin MD; Baranoski, Amy S. MD; Fonshell, Claudette RN; Reiter, David MD; Rosenwasser, Robert H. MD

BACKGROUND: Ventriculostomy infections create significant morbidity. To reduce infection rates, a standardized evidence-based catheter insertion protocol was implemented. A prospective observational study analyzed the effects of this protocol alone and with antibiotic-impregnated ventriculostomy catheters.

OBJECTIVE: To compare infection rates after implementing a standardized protocol for ventriculostomy catheter insertion with and without the use of antibiotic-impregnated catheters.

METHODS: Between 2003 and 2008, 1961 ventriculostomies and infections were documented. A ventriculostomy infection was defined as 2 positive CSF cultures from ventriculostomy catheters with a concurrent increase in cerebrospinal fluid white blood cell count. A baseline (preprotocol) infection rate was established (period 1). Infection rates were monitored after adoption of the standardized protocol (period 2), institution of antibiotic-impregnated catheter A (period 3), discontinuation of antibiotic-impregnated catheter A (period 4), and institution of antibiotic-impregnated catheter B (period 5).

RESULTS: The baseline infection rate (period 1) was 6.7% (22/327 devices). Standardized protocol (period 2) implementation did not change the infection rate (8.2%; 23/281 devices). Introduction of catheter A (period 3) reduced infections to 1.0% (2/195 devices, P = .0005). Because of technical difficulties, this catheter was discontinued (period 4), resulting in an increase in infection rate (7.6%; 12/157 devices). Catheter B (period 5) significantly decreased infections to 0.9% (9 of 1001 devices, P = .0001). The Staphylococcusinfection rate for periods 1, 2, and 4 was 6.1% (47/765) compared with 0.2% (1/577) during use of antibiotic-impregnated catheters (periods 3 and 5).

CONCLUSIONS: The use of antibiotic-impregnated catheters resulted in a significant reduction of ventriculostomy infections and is recommended in the adult neurosurgical population.

Full article access for Neurosurgery subscribers.

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Written by NEUROSURGERY® Editorial Office

July 2, 2010 at 9:00 AM

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