BackgroundWhile Bactiseal catheters have been shown to decreaseventriculo-peritoneal shunt infection rates, similar evi-dence for external ventricular drains (EVD) is lacking[1]. This retrospective study was undertaken to evaluatewhether the introduction of Bactiseal EVD in 2004 hasdecreased infection rates.Materials and methodsOne hundred and ten patients had undergone EVDinsertions from January 2000 to March 2008. Afterexcluding patients who had died within 5 days of theprocedure and also those with pre-existing CSF sepsis, atotal of 90 patients (with 119 EVD insertions- 66 Stan-dard, 53 Bactiseal) were included in the study. The prac-tice of sending catheter tips for culture was started withthe introduction of Bactiseal drains. The parameters stu-died were age, sex, ASA score, grade of surgeon, signifi-cant medical history, trauma, concurrent surgeries,revisional surgery, peri-operative antibiotic, Bactiseal,tunnelling and duration of drainage. The incidence ofexternal ventricular drain related ventriculitis, cathetertip colonisation and the responsible pathogens werenoted.ResultsEleven cases of ventriculitis were recorded and themajority were caused by Gram positive bacteria. BothBactiseal and standard catheters were associated withsimilar infection rates (Fishers Exact test, p= 0.53). A sig-nificantly longer average length of in-situ stay of ventri-cular catheters was observed in the cases developingventriculitis (Kolmogorov-Smirnov test, p<0.01). TheBactiseal catheters took longer time to develop infectionas compared to Standard catheters. But, this differencewas not statistically significant (Kaplan-Meier survivalanalysis, p = 0.12). Analysis comparing infectionincidence for the rest of the risk factors shows that onlyrevisional surgery was associated with higher infectionrates (Fishers Exact test, p= 0.03). Twenty sixBactisealcatheter tips were sent for culture, including catheter tipsfor 6 cases with ventriculitis. Only 2 catheters were foundto be colonised and Pseudomonas was cultured fromboth (1 with and 1 without associated ventriculitis).ConclusionsVentriculostomy related infections are strongly associatedwith longer in-situ stay of ventricular catheters. Bactisealcatheters may be the preferred option in those patientsneeding prolonged ventricular drainage. As comparedwith historical controls [2],Bactisealventriculostomycatheters have a low rate of colonisation and Pseudomonasseems to be the major culprit. 1. Prevention of infection inneurosurgery: role of “antimicrobial” catheters.