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

OBJECTIVE: Prophylactic antibiotics are routinely administered to patients with external ventricular drains (EVDs); however, no conclusive evidence su pports this practice. This study compared the efficacy and cost of prophyla ctic and periprocedural antibiotics in patients with EVDs. METHODS: We reviewed the charts of 308 patients who had an EVD in place for 3 or move days between January 1996 and lune 1997. Patients with EVDs plac ed for shunt infections or meningitis were excluded. A standard protocol wa s 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 us ed at the discretion of the attending neurosurgeon. Patients were divided i nto two groups: Group A comprised 209 patients who received prophylactic an tibiotics for the duration of the EVD (intravenously administered cefuroxim e, 1.5 g every 8 h); Group B comprised 99 patients who received only peripr ocedural 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 Gr oup B, the two groups were otherwise well matched, with no significant diff erences 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 Grou p 8 (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 o rganisms. Discontinuing the use of prophylactic antibiotics for EVDs at the authors' institution would save approximately $80,000 per year in direct d rug costs.