Antibiotic-impregnated catheters for the prevention of CSF shunt infections: a systematic review and meta-analysis

Context. CSF infections are a serious complication of CSF shunts and external ventricular drains (EVDs). Antibiotic-impregnated catheters (AIC) have been tried in order to minimise the risk of such infections. Objectives. To conduct a systematic review and a meta-analysis comparing AICs versus non-AICs used as ventriculo-peritoneal (VP) shunts or external ventricular drains (EVDs) in the neonatal population. The secondary aim was to include data from a paediatric and adult population if insufficient information was available from neonatal studies. Data sources. PubMed (March 2011), EMBASE (March 2011), CENTRAL (1980-March 2011), and CINAHL (March 2011) were searched. Study selection. Both randomised controlled trials (RCTs) and observational studies were included. Results. Only three observational studies reported on the use of AI-VP shunt catheters in the neonatal population. Meta-analysis found a statistically significant difference favouring AI shunts (RR: 0.37; CI: 0.16, 0.86; p = 0.02). Twelve studies (one RCT, 11 observational; n = 3284) compared AI versus non-AI VP shunts in a paediatric and adult population. The RCT showed a trend towards benefit using the AICs (RR: 0.38; 95% CI: 0.11, 1.30; p = 0.12). A meta-analysis of the 11 observational studies showed a significant benefit in the AI group (RR: 0.37; CI: 0.23, 0.60; p < 0.0001; n = 3149). Similar benefits were noted for AI-EVDs in RCTs (RR: 0.19; 95% CI: 0.05, 0.64; p = 0.01; n = 472, two studies) and observational studies (RR: 0.31; 95 CI: 0.13, 0.74; p = 0.009; n = 2415, five studies). Conclusions. A meta-analysis of mainly observational studies suggests that AICs may be an effective way of reducing the incidence of shunt and EVD infections. Well-designed multi-centre RCTs are urgently needed.