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  • Antimicrobial Prophylaxis and Coated EVD Catheters for Preventing Ventriculostomy-Related Infections: A Meta-Analysis of 5,168 Cases

    Final Number:

    John Patrick Sheppard; Vera Ong; Courtney Duong BS; Carlito Lagman MD; Thien Phuc Nguyen BS; Methma Udawatta; Giyarpuram Prashant MD; David Plurad; Dennis Kim; Isaac Yang MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    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.


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