Prophylactic antibiotics with intracranial pressure monitors and external ventricular drains: A review of the evidence

BACKGROUND The role of prophylactic antibiotics (PABs) in preventing infect ions associated with intracranial pressure (ICP) monitors and external vent ricular drains (EVD) is not well defined. METHODS This study includes an analysis of published reports and a survey o f current practices regarding the use of PABs with ICP monitors and EVDs. A computerized data search and a review of the abstracts from two major nati onal neurosurgical meetings over the past decade yielded 85 related article s. Three independent investigators, blinded to the title, author(s), instit ution(s), results, and conclusions of the articles used predetermined inclu sion criteria to select studies for meta-analysis. Thirty-six responses wer e returned from 98 questionnaires (37%) mailed to university neurosurgical programs. RESULTS Among the articles reviewed, only two studies met the predetermined inclusion criteria for the meta-analysis, and they were of insufficient si ze to produce statistically significant results. Among the 36 programs that responded to the survey, 26 (72%) used PABs, mainly cephalosporins (46%) a nd semisynthetic penicillins (38%), with ICP monitors and EVDs. Twenty-two (85%) used one drug, and 4 (15%) used two drugs. Twenty-two (61%) of the to tal group reported intra-institutional variation in practices among individ ual staff neurosurgeons. Nineteen (53%) expressed interest in a retrospecti ve study, and 27 (75%) expressed interest in a prospective study on the rol e of PABs in minor neurosurgical procedures. CONCLUSION No consensus regarding the use of PABs with ICP monitors and EVD s is noted. Randomized controlled trials of sufficiently large size with ap propriate blinding are needed to address this issue. (C) 1999 by Elsevier S cience Inc.