Effectiveness of antibiotic-impregnated catheters versus standard catheters on ventriculostomy-related infections

Abstract

Overview of the topic: Intracranial pressure changes due to various aetiologies. The Monroe-Kellie Hypothesis states that compensation by the brain mass, the blood or the cerebrospinal fluid (CSF) is needed to maintain a normal ICP. Surgical intervention and an external ventricular drain (EVD) insertion may be performed for excess CSF drainage. Intra-ventricular catheters (IVC) are the golden standard of EVDs; however patients run a high risk of ventriculostomy- related infections (VRI) of 5-10% (Walti et al., 2013). The research question and its PICO elements Do (I) antibiotic-impregnated cranial ventricular catheters (O) reduce the rate of infection (C) more than standard catheters and systemic antibiotics (P) in adult patients with an external ventricular drain (EVD)? Inclusion criteria applied Studies in English published from 1995-2014; prophylaxis of VRIs; adult participants aged 18 years and over who required an EVD insertion. Exclusion criteria applied Shunts; silver-impregnated catheters; the paediatric population; management of VRIs; and foreign language. Outcome of the search Six peer reviewed studies retrieved - three systematic reviews and meta-analyses, two randomised controlled trials (RCT) and a retrospective cohort study. Method of appraisal used The CASP tools and Crombie (1996) critical appraisal tool were used. Main results from the evidence Antibiotic-impregnated catheters (AIC) have a preventive effect, based on the results of the highest form of evidence SRs and MAs (Sonabend et al., 2011; Wang et al., 2013). Thomas et al. (2012) reviewed poorer quality studies and reported variation in the results for meta-analysis. The RCTs, Wong et al. (2010) and Pople et al. (2012) lack statistically significant results. The retrospective study Gutiérrez-González et al. (2010), report a non- statistically significant preventative effect by AICs. Conclusion AICs seem to decrease VRIs more than non-AICs and prophylactic systemic antibiotics (PSA). Implications and recommendations Further RCTs are necessary for achieving an affirmative conclusion about effectiveness of AICs. Locally, surveillance of VRIs is necessary to give a clear picture of the VRI rates. Cost-benefit analysis may be used to assess whether the use of AICs is worth the costs incurred. Additionally forums and discussions involving stakeholders and the MDT may instil motivation towards the best approach to decrease VRIs.