The efficacy and cost of prophylactic and periprocedural antibiotics in patients with external ventricular drains

Cargill Herley Alleyne, M. Hassan, J. M. Zabramski, W. A. Hall, D. F. Kelly, R. L. Macdonald, J. G. McComb, T. H. Milhorat

Research output: Contribution to journalArticle

139 Citations (Scopus)

Abstract

OBJECTIVE: Prophylactic antibiotics are routinely administered to patients with external ventricular drains (EVDs); however, no conclusive evidence supports this practice. This study compared the efficacy and cost of prophylactic and periprocedural antibiotics in patients with EVDs. METHODS: We reviewed the charts of 308 patients who had an EVD in place for 3 or more days between January 1996 and June 1997. Patients with EVDs placed for shunt infections or meningitis were excluded. A standard protocol was used to insert and monitor EVDs. Catheters were left in place as long as clinically indicated and changed only if they malfunctioned. Cerebrospinal fluid cultures were obtained twice weekly. Prophylactic antibiotics were used at the discretion of the attending neurosurgeon. Patients were divided into two groups: Group A comprised 209 patients who received prophylactic antibiotics for the duration of the EVD (intravenously administered cefuroxime, 1.5 g every 8 h); Group B comprised 99 patients who received only periprocedural antibiotics (intravenously administered cefuroxime, 1.5 g every 8 h, three or less doses). RESULTS: Although there were significantly more males in Group A than in Group B, the two groups were otherwise well matched, with no significant differences in age, indications, or duration of EVD placement. The overall rate of ventriculitis was 3.9%. The infection rates for Group A (3.8%) and Group B (4.0%) were almost identical CONCLUSION: Prophylactic antibiotics did not significantly reduce the rate of ventriculitis in patients with EVDs, and they may select for resistant organisms. Discontinuing the use of prophylactic antibiotics for EVDs at the authors' institution would save approximately $80,000 per year in direct drug costs.

Original languageEnglish (US)
Pages (from-to)1124-1129
Number of pages6
JournalNeurosurgery
Volume47
Issue number5
StatePublished - Nov 18 2000

Fingerprint

Anti-Bacterial Agents
Costs and Cost Analysis
Cefuroxime
Drug Costs
Infection
Meningitis
Cerebrospinal Fluid
Catheters

Keywords

  • Antibiotics
  • External ventricular drain
  • Intracranial pressure monitoring
  • Meningitis
  • Ventriculitis
  • Ventriculostomy

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Alleyne, C. H., Hassan, M., Zabramski, J. M., Hall, W. A., Kelly, D. F., Macdonald, R. L., ... Milhorat, T. H. (2000). The efficacy and cost of prophylactic and periprocedural antibiotics in patients with external ventricular drains. Neurosurgery, 47(5), 1124-1129.

The efficacy and cost of prophylactic and periprocedural antibiotics in patients with external ventricular drains. / Alleyne, Cargill Herley; Hassan, M.; Zabramski, J. M.; Hall, W. A.; Kelly, D. F.; Macdonald, R. L.; McComb, J. G.; Milhorat, T. H.

In: Neurosurgery, Vol. 47, No. 5, 18.11.2000, p. 1124-1129.

Research output: Contribution to journalArticle

Alleyne, CH, Hassan, M, Zabramski, JM, Hall, WA, Kelly, DF, Macdonald, RL, McComb, JG & Milhorat, TH 2000, 'The efficacy and cost of prophylactic and periprocedural antibiotics in patients with external ventricular drains', Neurosurgery, vol. 47, no. 5, pp. 1124-1129.
Alleyne CH, Hassan M, Zabramski JM, Hall WA, Kelly DF, Macdonald RL et al. The efficacy and cost of prophylactic and periprocedural antibiotics in patients with external ventricular drains. Neurosurgery. 2000 Nov 18;47(5):1124-1129.
Alleyne, Cargill Herley ; Hassan, M. ; Zabramski, J. M. ; Hall, W. A. ; Kelly, D. F. ; Macdonald, R. L. ; McComb, J. G. ; Milhorat, T. H. / The efficacy and cost of prophylactic and periprocedural antibiotics in patients with external ventricular drains. In: Neurosurgery. 2000 ; Vol. 47, No. 5. pp. 1124-1129.
@article{eb6f22957b984b9bb736d045dde8b98f,
title = "The efficacy and cost of prophylactic and periprocedural antibiotics in patients with external ventricular drains",
abstract = "OBJECTIVE: Prophylactic antibiotics are routinely administered to patients with external ventricular drains (EVDs); however, no conclusive evidence supports this practice. This study compared the efficacy and cost of prophylactic and periprocedural antibiotics in patients with EVDs. METHODS: We reviewed the charts of 308 patients who had an EVD in place for 3 or more days between January 1996 and June 1997. Patients with EVDs placed for shunt infections or meningitis were excluded. A standard protocol was used to insert and monitor EVDs. Catheters were left in place as long as clinically indicated and changed only if they malfunctioned. Cerebrospinal fluid cultures were obtained twice weekly. Prophylactic antibiotics were used at the discretion of the attending neurosurgeon. Patients were divided into two groups: Group A comprised 209 patients who received prophylactic antibiotics for the duration of the EVD (intravenously administered cefuroxime, 1.5 g every 8 h); Group B comprised 99 patients who received only periprocedural antibiotics (intravenously administered cefuroxime, 1.5 g every 8 h, three or less doses). RESULTS: Although there were significantly more males in Group A than in Group B, the two groups were otherwise well matched, with no significant differences in age, indications, or duration of EVD placement. The overall rate of ventriculitis was 3.9{\%}. The infection rates for Group A (3.8{\%}) and Group B (4.0{\%}) were almost identical CONCLUSION: Prophylactic antibiotics did not significantly reduce the rate of ventriculitis in patients with EVDs, and they may select for resistant organisms. Discontinuing the use of prophylactic antibiotics for EVDs at the authors' institution would save approximately $80,000 per year in direct drug costs.",
keywords = "Antibiotics, External ventricular drain, Intracranial pressure monitoring, Meningitis, Ventriculitis, Ventriculostomy",
author = "Alleyne, {Cargill Herley} and M. Hassan and Zabramski, {J. M.} and Hall, {W. A.} and Kelly, {D. F.} and Macdonald, {R. L.} and McComb, {J. G.} and Milhorat, {T. H.}",
year = "2000",
month = "11",
day = "18",
language = "English (US)",
volume = "47",
pages = "1124--1129",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - The efficacy and cost of prophylactic and periprocedural antibiotics in patients with external ventricular drains

AU - Alleyne, Cargill Herley

AU - Hassan, M.

AU - Zabramski, J. M.

AU - Hall, W. A.

AU - Kelly, D. F.

AU - Macdonald, R. L.

AU - McComb, J. G.

AU - Milhorat, T. H.

PY - 2000/11/18

Y1 - 2000/11/18

N2 - OBJECTIVE: Prophylactic antibiotics are routinely administered to patients with external ventricular drains (EVDs); however, no conclusive evidence supports this practice. This study compared the efficacy and cost of prophylactic and periprocedural antibiotics in patients with EVDs. METHODS: We reviewed the charts of 308 patients who had an EVD in place for 3 or more days between January 1996 and June 1997. Patients with EVDs placed for shunt infections or meningitis were excluded. A standard protocol was used to insert and monitor EVDs. Catheters were left in place as long as clinically indicated and changed only if they malfunctioned. Cerebrospinal fluid cultures were obtained twice weekly. Prophylactic antibiotics were used at the discretion of the attending neurosurgeon. Patients were divided into two groups: Group A comprised 209 patients who received prophylactic antibiotics for the duration of the EVD (intravenously administered cefuroxime, 1.5 g every 8 h); Group B comprised 99 patients who received only periprocedural antibiotics (intravenously administered cefuroxime, 1.5 g every 8 h, three or less doses). RESULTS: Although there were significantly more males in Group A than in Group B, the two groups were otherwise well matched, with no significant differences in age, indications, or duration of EVD placement. The overall rate of ventriculitis was 3.9%. The infection rates for Group A (3.8%) and Group B (4.0%) were almost identical CONCLUSION: Prophylactic antibiotics did not significantly reduce the rate of ventriculitis in patients with EVDs, and they may select for resistant organisms. Discontinuing the use of prophylactic antibiotics for EVDs at the authors' institution would save approximately $80,000 per year in direct drug costs.

AB - OBJECTIVE: Prophylactic antibiotics are routinely administered to patients with external ventricular drains (EVDs); however, no conclusive evidence supports this practice. This study compared the efficacy and cost of prophylactic and periprocedural antibiotics in patients with EVDs. METHODS: We reviewed the charts of 308 patients who had an EVD in place for 3 or more days between January 1996 and June 1997. Patients with EVDs placed for shunt infections or meningitis were excluded. A standard protocol was used to insert and monitor EVDs. Catheters were left in place as long as clinically indicated and changed only if they malfunctioned. Cerebrospinal fluid cultures were obtained twice weekly. Prophylactic antibiotics were used at the discretion of the attending neurosurgeon. Patients were divided into two groups: Group A comprised 209 patients who received prophylactic antibiotics for the duration of the EVD (intravenously administered cefuroxime, 1.5 g every 8 h); Group B comprised 99 patients who received only periprocedural antibiotics (intravenously administered cefuroxime, 1.5 g every 8 h, three or less doses). RESULTS: Although there were significantly more males in Group A than in Group B, the two groups were otherwise well matched, with no significant differences in age, indications, or duration of EVD placement. The overall rate of ventriculitis was 3.9%. The infection rates for Group A (3.8%) and Group B (4.0%) were almost identical CONCLUSION: Prophylactic antibiotics did not significantly reduce the rate of ventriculitis in patients with EVDs, and they may select for resistant organisms. Discontinuing the use of prophylactic antibiotics for EVDs at the authors' institution would save approximately $80,000 per year in direct drug costs.

KW - Antibiotics

KW - External ventricular drain

KW - Intracranial pressure monitoring

KW - Meningitis

KW - Ventriculitis

KW - Ventriculostomy

UR - http://www.scopus.com/inward/record.url?scp=0033758241&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033758241&partnerID=8YFLogxK

M3 - Article

VL - 47

SP - 1124

EP - 1129

JO - Neurosurgery

JF - Neurosurgery

SN - 0148-396X

IS - 5

ER -