Introduction: External ventricular drainage (EVD) is one of the most common neurosurgical procedures. Antibiotics- and silver-impregnated catheters were increasingly used to reduce ventriculostomy-related infections (VRI). The efficacy of these catheters in routine clinical setting and their impact on EVD-related complications is uncertain. The Hong Kong Neurosurgical Society performed a prospective, territory-wide, multi-center cohort study on EVD infection and complications after introduction of impregnated catheters in public neurosurgical centers.
Methods: Patients requiring EVD from January to December 2015 in seven public neurosurgical hospitals were recruited. Choice of catheters depended on treating surgeon’s discretion. Prospective collection of clinical and surgical data was performed with a standardized case report form. The primary outcome was ventriculostomy-related infections. Secondary outcomes were EVD complications including tract hemorrhage and blockage and risk factors for complications.
Results: 500 EVDs were included (260 impregnated and 240 conventional catheters). There was no significant difference in patient characteristics, except impregnated catheter group had a longer mean duration of drainage (9.6 days vs 7.6 days, p=.005), and less concurrent multiple EVDs (8.9% vs 16.9%, p=0.007).
Comparing the impregnated and conventional catheters cohort, there was no difference in ventriculostomy-related infection rate (1.5% vs 1.3%, p=0.78), and overall EVD-related complication rate (5.4% vs 5.7%, p=0.13). Infection in antibiotics-impregnated catheters were due to Methicillin-resistant Staphylococcus aureus while those in silver-impregnated and conventional catheters were due to non-resistant bacteria. Risk factor analysis did not yield significant patient or procedure factors causing VRI.
Conclusions: In one of the largest prospective EVD cohorts with use of impregnated catheters in routine clinical setting, the ventriculostomy-related infection rate was 1.4%. Our data suggested usage of antibiotics or silver-impregnated catheters, although safe, did not appear to further reduce infections when baseline infection rate was low.
Patient Care: This territory-wide multi-center prospective cohort study provide contemporary data on EVD-related infection and complications. It showed that use of impregnated catheters, although safe, did not further reduce infection rate in routine clinical setting in public neurosurgery centers.
Learning Objectives: 1. Ventriculostomy-related infection rate was low at 1.4% in this 500 EVDs cohort in seven public hospitals in Hong Kong.
2. Antibiotics-impregnated and silver-impregnated catheters while safe in routine clinical use, did not appear to further reduce infection rate.
3. Ventriculostomy-related infection in antibiotics-impregnated catheters are more likely due to resistant organisms such as Methicillin-resistant Staphylococcus aureus.