Article
Antiseptic silver-repleted external ventricular drains fail to reduce infection rate in catheter associated meningitis
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Published: | September 16, 2010 |
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Objective: To investigate the potential of external ventricular catheters fabricated with 2% of nano-particles of silver and insoluble silver-nitrates (Silverline®, Fa. Spiegelberg:) to reduce catheter associated meningitis (CAM) compared to conventional polyurethane catheters.
Methods: 272 patients requiring external ventricular drainage (EVD) met the inclusion criterias and were enrolled in this prospective, single-center study authorized by the local research ethics committee. 145 males and 127 females with a mean age of 56 (range 18–93) years at time of surgery were prospectively followed for the occurrence of CAM. CAM was diagnosed by local standard protocol (existence of two of the following criteria: increase of cell countCSF (CCCSF) >100% within 24 hours, clinical signs as fever, meningism, deterioration not due to the underlying disease and/or culture of a causative organism). The use of Silver-catheters or polyurethan catheters was preoperatively randomized for all patients. 129 Silverline®-catheters and 143 Polyurethan catheters were randomized.
Results: Student t-test revealed no difference between the two treatment groups (gender, age, duration of treatment with EVD). Main diagnoses leading to EVD were subarachnoidal hemorrhages due to a ruptured aneurysm (112 cases), non-aneurysmal intracerebral hemorrhage (63 cases) and tumors (56 cases). CAM was diagnosed in 39 patients (14.3%). 24 of the 129 Silverline® catheters (18.6%) and 15 of the Polyurethan catheters (10.5%) lead to CAM. The difference was statistically not significant (p=0.057) despite its strong tendency.
Conclusions: The antiseptic catheters repleted with nano-particles of silver failed grossly to reduce CAM compared to conventional catheters. The rate of CAM in the group of the Silverline® catheters was higher than in the conventional catheter group, though not statistically significant (p=0.057). Therefore, the use of these catheters cannot be recommended for reduction of CAM.