Prevention of ventriculostomy-related infections with prophylactic antibiotics and antibiotic-coated external ventricular drains: a systematic review

Neurosurgery. 2011 Apr;68(4):996-1005. doi: 10.1227/NEU.0b013e3182096d84.


Background: Ventriculostomy-related infection (VRI) is a severe complication of external ventricular drain use, occurring in 5% to 23% of patients. Preventive measures for VRI include prolonged prophylactic systemic antibiotics (PSAs) and an antibiotic-coated external ventricular drains (ac-EVDs).

Objective: We performed a systematic review of all studies evaluating PSAs and ac-EVD for VRI prevention through July 2010.

Methods: Two reviewers independently assessed eligibility and evaluated study quality based on pre-established criteria. Observational studies and randomized clinical trials (RCTs) that fulfilled inclusion criteria were included in the meta-analysis.

Results: Three RCTs and 7 observational studies met our inclusion criteria and were included in the analysis. The type of antibiotics and VRI definitions varied among these studies. Pooled analysis showed a protective effect of PSAs and ac-EVDs for VRI (risk ratio: 0.32; 95% CI: 0.18-0.56). Results showed moderate heterogeneity (I(2) = 53%) explained by the difference in quality among the studies and the inclusion of 1 large positive cohort study. The effect of PSAs and ac-EVDs was unrelated to the type of study (RCT or observational, P for interaction = .55), the route of antibiotic administration (PSAs or ac-EVDs, P = .13), or the quality of the studies (suboptimal vs good/excellent, P = .55).

Conclusion: RCTs and observational-derived evidence support the use of PSAs throughout the duration of external ventricular drainage; similarly, the use of ac-EVDs to prevent VRI seems to be beneficial. Available data are heterogeneous and of suboptimal quality. Further research is needed to confirm the findings of this meta-analysis. There are not sufficient data to compare the protective effect of ac-EVDs and PSAs.

Publication types

  • Comparative Study
  • Review
  • Systematic Review

MeSH terms

  • Animals
  • Anti-Bacterial Agents / administration & dosage*
  • Antibiotic Prophylaxis / methods*
  • Cerebrospinal Fluid Shunts / adverse effects
  • Cerebrospinal Fluid Shunts / instrumentation
  • Drainage / adverse effects*
  • Drainage / instrumentation
  • Humans
  • Randomized Controlled Trials as Topic / methods
  • Surgical Wound Infection / etiology
  • Surgical Wound Infection / prevention & control*
  • Ventriculostomy / adverse effects*
  • Ventriculostomy / instrumentation


  • Anti-Bacterial Agents