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Infection Rates in Standard vs. Hydrogel Coated Ventricular Catheters

Published online by Cambridge University Press:  02 December 2014

Anthony M. Kaufmann
Affiliation:
Section of Neurosurgery, University of Manitoba, Manitoba, MB, Canada
Tara Lye
Affiliation:
Community Health Sciences, University of Calgary, Calgary, AB, Canada
Gary Redekop
Affiliation:
Division of Neurosurgery, University of British Columbia, Vancouver, BC, Canada
Angela Brevner
Affiliation:
Division of Neurosurgery, University of British Columbia, Vancouver, BC, Canada
Mark Hamilton
Affiliation:
Division of Neurosurgery, University of Calgary, Calgary, AB, Canada
Michelle Kozey
Affiliation:
Section of Neurosurgery, University of Manitoba, Manitoba, MB, Canada
David Easton
Affiliation:
Calgary Laboratory Services, Calgary, AB, Canada
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Abstract

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Background:

Infection related to external ventricular drain (EVD) use is a common neurosurgical complication. Modified catheters with a hydrophilic surface may impede bacterial adherence and thereby reduce catheter related cerebrospinal fluid (CSF) infection.

Methods:

A prospective randomized clinical trial compared the occurrence of CSF infection related to use of either standard silastic or hydrogel coated EVD catheters (Bioglide®, Medtronic). Enrolment was available to all adult neurosurgery patients undergoing placement of a first EVD, at three university centers. The catheters were presoaked in a low concentration of bacitracin solution for 5-10 minutes prior to insertion. Bacterial infection was defined by heavy growth in a single CSF sample or light / medium growth in two consecutive samples. A secondary analysis was also conducted for “probable” CSF infection, including patients started on antibiotics after light / medium growth in a single CSF sample. Statistical analyses included Kaplan-Meier survival curve estimates accompanied by Log Rank and Breslow tests.

Results:

There were 158 randomized patients available to assess for EVD related infection of CSF. The two study groups had similar clinical characteristics including average duration of EVD use (8±4 days). Definite CSF infection occurred in seven and probable infection in another six (8% total). Infection incidence rose steadily from day 2 (1%) to day 11 (11%). There was no difference of daily occurrence of EVD infection between the two catheter types.

Conclusion:

Infection remains a common hazard in the use of EVD, and we found no reduction of infection using the hydrogel-coated catheters when presoaked in low concentration bacitracin solution.

Type
Other
Copyright
Copyright © The Canadian Journal of Neurological 2004

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