Authors: Mónica RiveroGarvía Javier MárquezRivas Manuel Enrique JiménezMejías Olaf Neth Ana Belén RuedaTorres
Publish Date: 2010/12/19
Volume: 153, Issue: 3, Pages: 647-651
Abstract
We report 648 cases of external ventricular drain from a total of 534 patients treated at the Virgen del Rocío Hospital between 1995 and 2006 Three subgroups were considered group 1 included patients treated between 1995 and 2000 as well as a total of 190 external ventricular drains and 59 cases of infection 3105 group 2 with patients treated between 2000 and 2004 and managed with a minimal handling protocol included 210 external ventricular drains and nine cases of infection 429 and group 3 treated between 2004 and 2006 with 248 external ventricular drains and six cases of infection 241 This latter subgroup included patients managed with a minimal handling protocol and antibioticimpregnated cathetersInfection rate was 17 when nonantibioticimpregnated catheters were employed and 241 when antibioticimpregnated catheters were inserted p 0001 This difference was statistically significant before and after the introduction of a minimal handling protocol with percentages of 531 and 327 respectively p 0001 odds ratio 008 absolute risk reduction 2726 However no statistically significant difference was observed in infection rate when the impact of a minimal handling protocol was considered 429 when only the protocol was introduced and 241 when both the protocol and antibioticimpregnated catheters were used p 005RivieroGarcia et al have analyzed their results about the rate of infection of external ventricular drainage EVD in a pediatric population A historical comparison of the results is made between a first period where no special protocol was used compared with a prospective second period where a minimal handling protocol MHP plus one single dose of Vancomycin given at the time of the catheter insertion was applied and a third period where the use of antibioticimpregnated catheter AIC rifampicin and clindamycin is added to the MHP Changing from the no protocol period to the MHP showed an important reduction of the rate of infection and adding the AIC showed even better results These findings are in accordance with reported recent studies about the prevention of CSF infections after EVD insertion Although there is a drastic decrease of the rate of infection in the last group of patients who benefited from the MHP and AIC the difference between the MHP and MHP plus AIC group is not statistically significant thus relativizing the effect of AIC also already reported by others Choux et al emphasized in the 1990s the necessity to adhere to a strict protocol for the handling of shunts to reduce the rate of CSF infection The results brought by the present study using a MHP for the insertion of an EVD confirm Choux et al principles
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