Antibiotic-Impregnated Versus Silver-Bearing External Ventricular Drainage Catheters: Preliminary Results in a Randomized Controlled Trial

• Published in: Neurocritical care 2013-04, Vol.18 (2), p.161-165
• Main Authors: Winkler, K. M. L., Woernle, C. M., Seule, M., Held, U., Bernays, R. L., Keller, E.
• Format: Article
• Language: English
• Subjects: Acute Disease; Adult; Aged; Aneurysms; Antibiotics; Bacterial Infections - cerebrospinal fluid; Bacterial Infections - epidemiology; Bacterial Infections - prevention & control; Catheters; Catheters - adverse effects; Catheters - classification; Catheters - microbiology; Cerebral Ventricles - microbiology; Cerebral Ventricles - pathology; Cerebral Ventricles - surgery; Cerebrospinal fluid; Clinical trials; Coated Materials, Biocompatible - therapeutic use; Costs; Critical Care Medicine; Drainage - instrumentation; Female; Hemorrhage; Humans; Hydrocephalus; Infections; Intensive; Internal Medicine; Intracranial Hemorrhages - therapy; Male; Medicine; Medicine & Public Health; Microorganisms; Middle Aged; Neurology; Neurosurgery; Neurosurgical Procedures - adverse effects; Neurosurgical Procedures - statistics & numerical data; Original Article; Patients; Pilot Projects; Prospective Studies; Reoperation - statistics & numerical data; Revisions; Silver - therapeutic use; Single-Blind Method
• ISSN: 1541-6933; 1556-0961
• DOI: 10.1007/s12028-013-9816-3

Background Evaluation of antibiotic-impregnated (AI) and ionized silver particle coated external ventricular drainage catheters (EVD) in patients with subarachnoid (SAH) or intracranial hemorrhage (ICH). Methods Between February 2011 and June 2012, 40 patients with acute hydrocephalus due to SAH, ICH or intraventricular hemorrhage were enrolled in a prospective, randomized, mono-center pilot study. Primary endpoints were defined as: number of events of cerebrospinal fluid (CSF) infections. Secondary endpoints were defined as: neurosurgical complications following the placement of the EVD, number of revisions of EVD catheters, and cost effectiveness. Results Sixty-one EVD placements in 40 patients, 32 antibiotic-coated (Bactiseal ® ), 29 silver-bearing catheters (VentriGuard ® ), have been performed. Confirmed or high suspicion of CSF infections occurred in 11 out of 61 events (confirmed infection: p  = 0.71, probable infection: p  = 0.90). Revisions of EVD were needed in 13 cases (22 %) due to CSF infection, dysfunction, impaired healing, or malplacement ( p  = 0.37). Conclusion Regarding CSF infection rate and dysfunction, no statistical significant differences between the two EVD catheters Bactiseal ® versus VentriGuard ® were found. The silver-bearing catheter might offer a safe and cost-conscious alternative to the AI catheter.