2017 Infectious Diseases Society of America's Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis.
INTRODUCTION Previous prospective study in our unit had shown that the use of dual antibiotic prophylaxis in patients with external ventricular drain was associated with decreased incidence of cerebrospinal fluid infection but complicated with opportunistic extracranial infection. In recent years, cerebrospinal fluid shunt catheters impregnated with antimicrobial agents have become available. Theoretically, these catheters provide antibiotic prophylaxis locally without the associated complications of systemic opportunistic infection. METHODS We carried out a prospective randomized, controlled clinical trial in a regional neurosurgical center in Hong Kong. We recruited patients admitted for emergency neurosurgical operation after informed consent was obtained from next-of-kin. Eligible patients were randomized to receive an antibiotic-impregnated ventricular catheter or plain ventricular catheter Dual prophylactic antibiotic coverage was given to the patients randomized for plain ventricular catheter only. Patients who received antibiotic impregnanted catheters were not treated with systematic prophylactic antibiotics. Here we present the analysis of 110 patients, recruited over a 2-year period, to receive antibiotic-impregnanted ventricular catheters versus non-impregnated ventricular cathethers with prophylactic antibiotic coverage. FINDINGS Fifty-two patients were randomized to antibiotic-impregnated ventricular catheter with no systemic antibiotic prophylaxis (Group A) and 58 patients were randomized to plain ventricular catheters with prophylactic dual antibiotics (Group B). There was no ventriculostomy-related infection in either groups of patients. There was also no statistical significant difference in incidences of extracranial infections between the two groups, p = 0.617. CONCLUSIONS In this analysis, antibiotic-impregnation of ventricular catheters was as effective as systemic antibiotics in the prevention of ventriculostomy infections, with the potential advantage of avoiding the systemic side-effects of prophylactic antibiotics.