Efficacy of periprocedural vs extended use of antibiotics in patients with external ventricular drains - A randomized trial

Background: External ventricular drains (EVD) are considered gold standard for intracranial pressure monitoring. Antibiotics are routinely administered to patients with EVD for extended duration, however, no conclusive evidence supports this practice. Aim: To compare the efficacy of periprocedural versus extended use of antibiotics, in patients requiring external ventricular drains. Patients and methods: This is a three year prospective study starting from 1st Jan 2002. All patients who required EVDs as part of their treatment protocol were randomized into two groups, group A who received periprocedural antibiotics and group B who received, antibiotics for extended duration, while EVD was in situ. Patients with open head injuries, preexisting CNS infection, who required EVD for second time, breach in surgical technique and who had antibiotics for other reasons were excluded from this study. A standard protocol was used to insert and monitor EVDs. No EVD was left in situ for a period more than 144 h. Cerebrospinal fluid cultures were sent on day 0, 1, 3 and 5. On removal, EVD tip was sent for culture. Group A received two doses of intravenously administered ceftazidime. Group B received ceftazidime extended till removal of EVD. Results: Both groups were well matched in number of patients, age, sex, duration of ventriculostomy Closed head injury was the most common indication (42.86%) for ventriculostomy. One patient in group A (6.67%) and two patients in group B (7.40%) had ventriculostomy related infection with overall infection rate of 7.14%. Conclusion: Our observation, despite being underpowered, definitely points towards limiting the antibiotic prophylaxis to only periprocedural period for clean neurosurgical procedures like ventriculostomy. Copyright (C) 2012, Neurotrauma Society of India. All rights reserved.