International and Specialty Trends in the Use of Prophylactic Antibiotics to Prevent Infectious Complications after Insertion of External Ventricular Drainage Devices

Abstract

External ventricular drains (EVD) are used as a method of diverting cerebral spinal fluid out of the cranium. After placement of these drains, it has been customary to initiate antibiotics to prevent drain-related infections. Prophylactic regimes include peri-operative and prolonged administration of antibiotics. Little evidence exists to support either regime. To determine current practices or to determine if an unintended consensus has developed, a survey was taken concerning antibiotic prophylaxis with EVD insertion. E-mail survey from a membership database of the Neurocritical Care Society, a database of neurosurgeons maintained by the LSU Department of Neurosurgery and infectious diseases practitioners from a Department of Medicine database. There was an approximate 781 responses. Of the responders, 77% (599) were neurosurgeons, 10.5% (82) neurocritical care, 5.0% (41) intensivists, 6.5% (50) infectious diseases specialist, and 1% (9) others. The majority of responders (64%) have been in practice > 10 years. Most respondents from outside Europe recommended use of prophylactic antibiotics. Of those that did use antibiotics prophylaxis, the majority (56%) recommend use for the duration the catheter is in place. The exception is European responders used peri-operative prophylaxis most frequently. The majority of responders (78%) support a prospective trial to address this issue. The use of antibiotics prophylaxis after EVD placement is disparate among specialties that deal with EVD placement and complications. There is no consistent practice pattern based on specialty, locale, and years of practice. The majority of all responders felt a prospective trial was warranted.