Do antibiotic-impregnated catheters prevent infection in CSF diversion procedures? Review of the literature

Cerebrospinal fluid shunting devices are foreign bodies internally or externally placed in a patient with the aim of improving the prognosis. Device-related infection is the most serious complication. Its importance arises from the high frequency of occurrence and the consequences that it implies in terms of morbidity and mortality. As a result, the presence of these two factors increases significantly hospital costs. Among many primary prevention measures investigated, one of those that has gained in importance over the last years is the use of antibiotic-impregnated catheters. Although their experimental development dates back to the 1970s, experience in clinical practice has not been settled until the last decade. This is the reason why only 22 studies on the usefulness of AICs in CSF shunting procedures in clinical practice have been published in the literature since their commercialization. Although experience with antibiotic-impregnated shunts continues growing, practice with antibiotic-impregnated external ventricular drains is much shorter. The present study reviews and analyses the different investigations performed in order to determine the efficacy of antibiotic-impregnated shunts and external ventricular drains with the aim of reducing device-related infectious complications. The results suggest that AICs reduce device-related infection as well as hospital costs. However, evidence is not enough to state categorical conclusions, and further large, prospective, randomized and double-blind studies must be performed in order to confirm these results and the efficacy of other antibiotic-impregnated devices. Further economic evaluation is required to confirm the benefit in terms of cost-effectiveness as well. (c) 2010 The British Infection Society. Published by Elsevier Ltd. All rights reserved.