Efficacy of Antimicrobial-Impregnated External Ventricular Drain Catheters: A Prospective, Randomized, Controlled Trial

Abstract
Background: Insertion of External Ventricular Drain (EVD) is associated with considerable risk of Cerebrospinal Fluid (CSF) infection which is a life-threatening complication. Infection occurs when microorganisms colonize along the catheter surface.
Aim of Study: The aim of this study is to compare the safety & efficacy of EVD catheters impregnated with Clin-damycin & rifampin with those of standard control catheters for prevention of the catheter-related infections.
Subjects and Methods: The prospective study was con-ducted on forty patients between April 2013 – November 2014. All patients were randomly assigned to undergo place-ment of an EVD with a catheter impregnated with Clindamycin & rifampin or a standard non-impregnated catheter (control group). Each group included twenty patients. Standard silicone catheter was the EVD used in both cohorts. Patients diagnosed with a known or suspected CSF infection were excluded from this study. Initial cell counts and cultures were obtained from the CSF, repeated at intervals (72 hours) and at time of Catheter removal. CSF infection rate and its impacton the clinical outcome were evaluated in both groups.
Results: Among this series of forty patients with EVDs, three had an EVD-associated CSF infection in the control group giving an infection rate within this group of 15% per patient. Only one case in the Antibiotics-impregnated Catheter (AIC) group had CSF infection. Positive CSF cultures were obtained on day 10, 12 & 14 respectively. Organism isolated from CSF cultures was mainly gram-negative infection. AIC group showed a significant low infection rate compared to the uncoated one (p<0.001).
Conclusion: The Catheters impregnated with the antibiotic combination of Clindamycin and rifampin appears to be safe and effective in reducing the risk of infectious complications associated with the placement of an EVD.