Background: External ventricular drainage (EVD)-related infection (ERI) represents an important condition with potential high morbidity with significant impact on patient outcomes. Prophylactic systemic antibiotics are routinely administered to patients with EVD, but they do not significantly lower the incidence of ERIs. Intraventricular treatment with vancomycin appeared to be safe and effective, but most reports are case-reports/-series and retrospective studies. Methods: A prospective non-randomized case-control study was conducted in a consecutive series of 116 patients treated with EVD insertion. The study includes the group of patients treated with intrathecal vancomycin (Group A, 62 patients) compared with the control group treated with daily intravenous cefazolin (Group B, 54 patients). Results: No statistically significant differences were found between the 2 groups with regard to the duration of catheterization and occurrence of ERI during hospitalization. EVD was replaced in 16 cases (25.8%) in group A and in 12 cases (22.2%) in the control group B (P 0.67). Three cases (4.8%) of ERI have been found in group A and 5 (9.3%) in the control group (P = 0.34). All reported cases of infection in group A were caused by gram-negative agents; on the opposite, cases of infections in the control group B were caused above all by gram-positive bacteria with a statistical difference (P = 0.03). Conclusions: In this first prospective study on this topic, we found that intrathecal Vancomycin administration in EVDs does not reduce the occurrence of ERI compared with intravenous cefazolin prophylaxis, but induces selection of gram-negative bacteria.

The use of intraventricular instillation of vancomycin to prevent external ventricular drainage related infection: a clinical prospective study / Tartara, F.; Armocida, D.; Cofano, F.; Guerrini, F.; Vigano, M.; Zoia, C.; Boeris, D.; Garbossa, D.. - In: WORLD NEUROSURGERY. - ISSN 1878-8769. - 167:(2022), pp. 527-532. [10.1016/j.wneu.2022.08.048]

The use of intraventricular instillation of vancomycin to prevent external ventricular drainage related infection: a clinical prospective study

Armocida D.
Secondo
Writing – Original Draft Preparation
;
2022

Abstract

Background: External ventricular drainage (EVD)-related infection (ERI) represents an important condition with potential high morbidity with significant impact on patient outcomes. Prophylactic systemic antibiotics are routinely administered to patients with EVD, but they do not significantly lower the incidence of ERIs. Intraventricular treatment with vancomycin appeared to be safe and effective, but most reports are case-reports/-series and retrospective studies. Methods: A prospective non-randomized case-control study was conducted in a consecutive series of 116 patients treated with EVD insertion. The study includes the group of patients treated with intrathecal vancomycin (Group A, 62 patients) compared with the control group treated with daily intravenous cefazolin (Group B, 54 patients). Results: No statistically significant differences were found between the 2 groups with regard to the duration of catheterization and occurrence of ERI during hospitalization. EVD was replaced in 16 cases (25.8%) in group A and in 12 cases (22.2%) in the control group B (P 0.67). Three cases (4.8%) of ERI have been found in group A and 5 (9.3%) in the control group (P = 0.34). All reported cases of infection in group A were caused by gram-negative agents; on the opposite, cases of infections in the control group B were caused above all by gram-positive bacteria with a statistical difference (P = 0.03). Conclusions: In this first prospective study on this topic, we found that intrathecal Vancomycin administration in EVDs does not reduce the occurrence of ERI compared with intravenous cefazolin prophylaxis, but induces selection of gram-negative bacteria.
2022
brain trauma; cerebrospinal fluid; external ventricular drainage; intrathecal therapy; neurosurgery; prophylactic antibiotics; vancomycin
01 Pubblicazione su rivista::01a Articolo in rivista
The use of intraventricular instillation of vancomycin to prevent external ventricular drainage related infection: a clinical prospective study / Tartara, F.; Armocida, D.; Cofano, F.; Guerrini, F.; Vigano, M.; Zoia, C.; Boeris, D.; Garbossa, D.. - In: WORLD NEUROSURGERY. - ISSN 1878-8769. - 167:(2022), pp. 527-532. [10.1016/j.wneu.2022.08.048]
File allegati a questo prodotto
File Dimensione Formato  
Tartara_The Use of_2022.pdf

solo gestori archivio

Tipologia: Versione editoriale (versione pubblicata con il layout dell'editore)
Licenza: Tutti i diritti riservati (All rights reserved)
Dimensione 287.25 kB
Formato Adobe PDF
287.25 kB Adobe PDF   Contatta l'autore

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1678753
Citazioni
  • ???jsp.display-item.citation.pmc??? 0
  • Scopus 2
  • ???jsp.display-item.citation.isi??? 1
social impact