Antimicrobial-impregnated external ventricular catheters: does the very low infection rate observed in clinical trials apply to daily clinical practice?

Abstract

A recent multicenter, randomized, prospective study using antimicrobial-impregnated ventricular catheters (AIVCs) has demonstrated a dramatic reduction in the incidence of catheter-related infections. By necessity, such trials are subject to notoriously close and careful monitoring; thus, the results of multicenter, randomized clinical trials do not automatically apply to daily clinical practice. The aim of the present study was to establish whether the very low incidence of ventriculitis with AIVCs reported in these trials is also observed in routine clinical practice. Data on 139 consecutive patients admitted to a Neurocritical Intensive Care Unit who underwent placement of 154 AIVCs were reviewed. All patients included in the data analysis had an AIVC for at least 48 hours, and cultures as well as cell counts were obtained from the CSF at various intervals after placement of the AIVC. One hundred thirteen catheters in 100 patients met criteria for inclusion in the analysis. There were four positive cultures. In three patients, the culture result was thought to be a contaminant (because it was not corroborated by clinical findings or cell count or because of the characteristics of the culture). Only one gram-negative infection was considered to be clinically significant (0.88% of catheters, 1.00% of patients) and confirmed on clinical and other laboratory grounds. The very low infection rate with currently available AIVCs observed in rigorously controlled clinical trials translates to routine clinical practice.