Lackner Peter, Beer Ronny, Broessner Gregor, Helbok Raimund, Galiano Klaus, Pleifer Claudia, Pfausler Bettina, Brenneis Christian, Huck Christian, Engelhardt Klaus, Obwegeser Alois A, Schmutzhard Erich
Department of Neurology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria.
Neurocrit Care. 2008;8(3):360-5. doi: 10.1007/s12028-008-9071-1.
Catheter-associated infection of cerebrospinal fluid (CSF) is a potentially life-threatening complication of external ventricular drainage (EVD). The purpose of this pilot study was to address the efficacy of silver-impregnated EVD catheters in neurological and neurosurgical patients requiring external CSF drainage due to acute occlusive hydrocephalus.
Nineteen consecutive patients were enrolled in the treatment arm of the study and data were prospectively recorded for these patients. The control group consisted of 20 patients for whom data were retrospectively assessed. CSF samples were drawn at least three times a week and routine bacterial cultures and CSF analyses were done according to standard protocols. The primary endpoint of the study was the occurrence of catheter-associated ventriculitis (CAV) proven by positive CSF culture. Secondary endpoints were bacterial colonization of the catheter tip and CSF pleocytosis.
In 20 control patients, 5 CAVs were microbiologically diagnosed. In contrast, no positive CSF cultures were found in the treatment group. This difference was statistically significant (P < 0.05). All CAVs occurred later than day 10 after catheter placement. Colonization of the catheter tip was found in 6 patients in the control group and in 5 patients in the treatment group (not significant).
This pilot study indicates that EVD catheters impregnated with silver nanoparticles might be a new option for preventing CAV in neurocritical care patients, and therefore evaluation in a large prospective randomized study is warranted.
脑脊液（CSF）导管相关感染是脑室外引流（EVD）的一种潜在危及生命的并发症。本前瞻性研究的目的是探讨银浸渍EVD导管对因急性梗阻性脑积水而需要进行外部CSF引流的神经科和神经外科患者的疗效。
本研究的治疗组纳入了19例连续患者，并对这些患者进行了前瞻性数据记录。对照组由20例患者组成，对其数据进行回顾性评估。每周至少采集3次CSF样本，并根据标准方案进行常规细菌培养和CSF分析。本研究的主要终点是CSF培养阳性证实的导管相关脑室炎（CAV）的发生。次要终点是导管尖端的细菌定植和CSF细胞增多。
在20例对照患者中，有5例经微生物学诊断为CAV。相比之下，治疗组未发现CSF培养阳性。这种差异具有统计学意义（P < 0.05）。所有CAV均发生在置管后第10天以后。对照组有6例患者、治疗组有5例患者发现导管尖端定植（无显著性差异）。
这项前瞻性研究表明，银纳米颗粒浸渍的EVD导管可能是预防神经重症监护患者CAV的一种新选择，因此有必要在大型前瞻性随机研究中进行评估。
