Department of Anesthesia and Surgical Intensive Care, Henri Mondor University Hospital Assitance Publique-Hôpitaux de Paris (APHP), University Paris-Est-Créteil (UPEC), Créteil, France.
Groupe de Recherche Clinique IMPACT, Institut Mondor de la Recherche Biomédicale, Université Paris-Est Créteil (UPEC), Créteil, France.
J Antimicrob Chemother. 2019 Nov 1;74(11):3328-3336. doi: 10.1093/jac/dkz335.
Antibiotic-impregnated external ventricular drains (AI-EVDs) have a debated efficacy in clinical studies.
Our aim was to assess the durability of antimicrobial activity of AI-EVDs used in clinical settings.
From April 2017 to January 2018, all consecutive AI-EVDs (Bactiseal™) inserted in adult patients were prospectively included. After removal, each AI-EVD was cultured and assessed for antimicrobial activity on both internal and external sides of AI-EVDs. Catheters were each challenged with a single Staphylococcus strain [MSSA, MRSA or methicillin-resistant Staphylococcus epidermidis (MRSE)]. MS was used to measure residual concentrations of rifampicin and clindamycin.
Sixty-five AI-EVDs were included (56 patients). Among these, 21 were challenged with MSSA, 23 with MRSA and 21 with MRSE. Five ventriculostomy-related colonizations (9%) and two ventriculostomy-related infections (4%) occurred. Staphylococcus was the main bacterium responsible for colonization (4/5). AI-EVD inhibition decreased significantly against MRSA and MRSE according to duration of catheterization (for external and internal sides, P < 0.02) and overall volume of CSF drained (P < 0.005 for both sides against MRSE, P < 0.005 for external side against MRSA), but not against MSSA. Clindamycin concentration was not correlated with duration of catheterization or CSF volume drained, but <20% of initial concentration was recovered even after 5 days of AI-EVD dwelling. Conversely, rifampicin concentration showed a rapid and significant decline correlated to duration and CSF volume (P < 0.001 and P = 0.03, respectively).
Antimicrobial activity of AI-EVDs dropped quickly in vivo. Antimicrobial impregnation did not prevent AI-EVD colonization by susceptible strains in 9% of the cases.
抗生素浸渍的外部脑室引流管（AI-EVD）在临床研究中具有争议性的疗效。
我们旨在评估临床应用中 AI-EVD 的抗菌活性的耐久性。
从 2017 年 4 月至 2018 年 1 月，所有连续的 AI-EVD（Bactiseal™）插入成年患者均前瞻性纳入。取出后，对每个 AI-EVD 的内部和外部进行培养，并评估 AI-EVD 的抗菌活性。导管分别用单一金黄色葡萄球菌菌株（MSSA、MRSA 或耐甲氧西林表皮葡萄球菌（MRSE））进行挑战。MS 用于测量利福平和克林霉素的残留浓度。
共纳入 65 例 AI-EVD（56 例患者）。其中，21 例用 MSSA 挑战，23 例用 MRSA 挑战，21 例用 MRSE 挑战。发生了 5 例脑室造口术相关的定植（9%）和 2 例脑室造口术相关的感染（4%）。定植的主要细菌是金黄色葡萄球菌（4/5）。根据导管留置时间（外部和内部侧，P < 0.02）和引流的 CSF 总体量（对侧，P < 0.005 对 MRSE，P < 0.005 对外侧，对 MRSA），AI-EVD 对 MRSA 和 MRSE 的抑制作用显著降低，但对 MSSA 无影响。克林霉素浓度与导管留置时间或 CSF 引流量无关，但即使 AI-EVD 留置 5 天后，仍回收不到初始浓度的 20%。相反，利福平浓度迅速显著下降，与持续时间和 CSF 量呈负相关（P < 0.001 和 P = 0.03）。
AI-EVD 体内的抗菌活性迅速下降。在 9%的情况下，抗菌浸渍并不能防止 AI-EVD 被敏感菌株定植。
