R A Atkinson1, L Fikrey2, A Vail3, H C Patel4. 1. Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Manchester Academic Health Sciences Centre, Salford, UK; Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK. 2. Leiden University Medical Centre, Leiden, The Netherlands. 3. Centre for Biostatistics, The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK. 4. Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Manchester Academic Health Sciences Centre, Salford, UK; Vascular and Stroke Centre, Institute of Cardiovascular Sciences, The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK. Electronic address: hiren.patel@srft.nhs.uk.
Abstract
BACKGROUND: Cerebrospinal fluid (CSF) infection is the primary complication associated with placement of an external ventricular drain (EVD). The use of silver-impregnated EVD catheters has become commonplace in many neurosurgical centres. AIM: To assess the effect of silver-impregnated EVD catheter usage on catheter-related CSF infections. METHODS: A meta-analysis was performed by systematically searching Medline, Embase and the Cochrane Library. All randomized controlled trials (RCTs) and non-RCTs comparing silver-impregnated and plain EVD catheters were identified and analysed. FINDINGS: Six non-RCTs were included. The crude infection rate was 10.8% for plain catheters and 8.9% for silver-impregnated catheters [pooled odds ratio (OR) 0.71, 95% confidence interval (CI) 0.46-1.08; P = 0.11]. In a microbiological spectrum analysis, silver-impregnated catheters demonstrated a significantly lower rate of CSF infections caused by Gram-positive organisms (2.0% vs 6.7% in the silver-impregnated and plain catheter groups, respectively; pooled OR 0.27, 95% CI 0.11-0.63; P = 0.002). CONCLUSION: The antimicrobial effects of silver-impregnated EVD catheters may be selective, and may need to be evaluated further in a prospective, controlled manner.
BACKGROUND: Cerebrospinal fluid (CSF) infection is the primary complication associated with placement of an external ventricular drain (EVD). The use of silver-impregnated EVD catheters has become commonplace in many neurosurgical centres. AIM: To assess the effect of silver-impregnated EVD catheter usage on catheter-related CSF infections. METHODS: A meta-analysis was performed by systematically searching Medline, Embase and the Cochrane Library. All randomized controlled trials (RCTs) and non-RCTs comparing silver-impregnated and plain EVD catheters were identified and analysed. FINDINGS: Six non-RCTs were included. The crude infection rate was 10.8% for plain catheters and 8.9% for silver-impregnated catheters [pooled odds ratio (OR) 0.71, 95% confidence interval (CI) 0.46-1.08; P = 0.11]. In a microbiological spectrum analysis, silver-impregnated catheters demonstrated a significantly lower rate of CSF infections caused by Gram-positive organisms (2.0% vs 6.7% in the silver-impregnated and plain catheter groups, respectively; pooled OR 0.27, 95% CI 0.11-0.63; P = 0.002). CONCLUSION: The antimicrobial effects of silver-impregnated EVD catheters may be selective, and may need to be evaluated further in a prospective, controlled manner.