Introduction: Infection from an external ventricular drain (EVD) can result in significant morbidity and hospital costs. Antibiotic-impregnated catheters (AiEVDs) have been reported to reduce the risk of CSF infection in patients requiring EVD catheters. We investigated the efficacy of AiEVDs in reducing rates of CSF-related infection and ventriculitis rates at a single center, and performed a cost-effectiveness analysis.
Methods: Subjects receiving an AiEVD were prospectively enrolled in an cohort study with a historical control. All adult patients requiring an EVD, subdural drain, or tumor cavity drain from January, 2014 through March, 2015 received a clindamycin/rifampin-impregnated EVD. Patients undergoing insertion of standard catheters from 2012-2013 were used as the historical control. CSF was sampled per routine on a weekly basis and prior to catheter removal. Cost-effectiveness analyses were performed based on estimated hospital stay costs (e.g. extended ICU stay).
Results: 117 patients received AiEVD during the study period, and data from 108 were included in the analysis. Nine patients were excluded from analysis: 7 had catheters in place for fewer than 24 hours and 2 had known pre-existing CSF infections. The AiEVD group was compared to a historical control group (n=108). The two groups had similar clinical characteristics, including patient sex and age, indication for catheter placement, and length of time the catheter remained in place. The most common indications for EVD placement were subarachnoid hemorrhage (43.3%) and intraparenchymal hemorrhage (22.6%). Mean time before EVD removal was 9.3 days. There were no catheter-based infections in the AiEVD group, with 8/108 (7.4%) in the control group (p = 0.004), with a number needed to treat of 13.5. In patients with CSF pleiocytosis suggestive of ventriculitis, the AiEVD group demonstrated shorter duration of ventriculitis. Our institution saved an average of $1,324 per patient by using AiEVD. There was a trend towards fewer patients requiring shunting in the AiEVD group (6.5%) compared to control group (9.3%).
Conclusions: The use of AiEVDs significantly reduced the rate of catheter-induced CSF infection and were significantly more cost-effective when compared to standard EVDs, because of decreased length of ICU admission and potential decrease in rate of shunt requirement.
Patient Care: Preventing and/or eliminating catheter-related infections will reduce morbidity and mortality of iatrogenic origin.
Learning Objectives: By the conclusion of this session, participants should be able to describe the benefits of antibiotic-impregnated external ventricular drain catheters.