Introduction: Placement of an external ventricular drains (EVDs) via ventriculostomy is an essential procedure in the management of neurocritical care patients. There remains no well-established routine regarding use of single-dose pre-operative antibiotics, perioperative systemic antibiotics (< 24-hrs), or no prophylaxis at all.
Methods: We searched MEDLINE for studies related to VRIs and antimicrobial prophylaxis. Eligible articles reported VRI incidence that included control and treatment cohorts evaluating extended (> 24 hrs) systemic antibiotics or ac-EVDs. Data extraction and analysis followed PRISMA guidelines.
Results: Of 604 articles, a total of 19 studies (3%) met eligibility criteria, reporting 5,168 ventriculostomy outcomes. Study heterogeneity was quantified using 2 and Q statistics. Bias was assessed using Funnel plot analysis. Risk ratios were aggregated by prevention strategy using fixed and random effects analyses. >24 hrs prophylaxis with intravenous antibiotics and ac-EVD usage were associated with risk ratios of 0.36 [0.14, 0.93] and 0.40 [0.22, 0.73], respectively, using random effects modeling. Random effects analysis of pooled cohort data yielded expected VRI incidence of 17-31% with no antimicrobials, 9-14% with perioperative (<24 hrs) intravenous (IV) therapy, 3-7% with extended IV therapy or ac-EVDs alone, and as low as 0-1% with extended IV therapy and ac-EVDs together.
Conclusions: Management with both extended systemic antibiotics and ac-EVDs could lower VRI risk, which could reduce mortality, improve outcomes, shorten hospital stays, and lower healthcare costs.
Patient Care: This research has aided in outlining a standard of care with EVDs. Possible benefits of implementing a similar routine may include lowering infection risks and reducing cost burdens on the patient.
Learning Objectives: Objective To analyze published evidence on efficacy of extended prophylactic antimicrobial therapy and antibiotic-coated external ventricular drains (ac-EVDs) in lowering ventriculostomy related infection (VRI) incidence.