Durability of antimicrobial activity of antibiotic-impregnated external ventricular drains: a prospective study.
J Antimicrob Chemother
; 74(11): 3328-3336, 2019 11 01.
Article
em En
| MEDLINE
| ID: mdl-31411688
ABSTRACT
BACKGROUND:
Antibiotic-impregnated external ventricular drains (AI-EVDs) have a debated efficacy in clinical studies.OBJECTIVES:
Our aim was to assess the durability of antimicrobial activity of AI-EVDs used in clinical settings.METHODS:
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.RESULTS:
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, Pâ<â0.02) and overall volume of CSF drained (Pâ<â0.005 for both sides against MRSE, Pâ<â0.005 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 (Pâ<â0.001 and Pâ=â0.03, respectively).CONCLUSIONS:
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.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Staphylococcus
/
Derivações do Líquido Cefalorraquidiano
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Drenagem
/
Catéteres
/
Antibacterianos
Tipo de estudo:
Observational_studies
Limite:
Adult
/
Aged
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Female
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Humans
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Male
/
Middle aged
Idioma:
En
Revista:
J Antimicrob Chemother
Ano de publicação:
2019
Tipo de documento:
Article
País de afiliação:
França