gms | German Medical Science

56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

Harmful use of prophylactic antibiotics in the treatment with external ventricular drainages to prevent infections of the cerebrospinal fluid

Kein Nutzen durch Antibiotikagaben bei der Therapie mit externen Ventrikeldrainagen zur Meningitis-Prophylaxe

Meeting Abstract

  • corresponding author O. Müller - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Essen
  • B. Schoch - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Essen
  • D. Hansen - Institut für Hygiene und Arbeitsmedizin, Universitätsklinikum Essen
  • W. Popp - Institut für Hygiene und Arbeitsmedizin, Universitätsklinikum Essen
  • D. Stolke - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Essen

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc10.05.-16.08

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2005/05dgnc0176.shtml

Veröffentlicht: 4. Mai 2005

© 2005 Müller et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

Administration of antibiotics for prophylactic purposes is controversially discussed. It is the aim of this study to answer the question, whether the prophylactic use of antibiotics in the treatment with external ventricular drains (EVD) does really prevent meningitis. We prospectively examined the infection rate of the cerebrospinal fluid (CSF) in patients with and without continuous administration of antibiotics treated with EVD at our department.

Methods

A total of 256 patients consecutively treated with 276 EVD were included in the study. Operative procedure was standardized for all patients, including subcutanous tunneling and perioperative administration of cefuroxim/gentamycin. CSF samples were examined three times a week for pleocytosis, microbiological cultures and elevation of liquor proteins. Infection was defined by two consecutive positive CSF cultures of the same strain in association with pleocytosis. In group A, 126 patients initially recieved continuous administration of ciprofloxacin 400mg intravenously, followed by oral administration from day three on. Breaking point of continuous antibiotic treatment was made after twelve months, whereafter 142 patients (group B) with need of EVD did not recieve prophylactic antibiotics anymore.

Results

In both groups mean duration of ventricular drainage was equal (9,7 days, range 1 – 34 days, in group A; and 9,3 days, range 1 – 39 days, in group B, respectively). The infection rate of the CSF in group A came up to 12,7% regarding the patients and 14,9% referring to the total number of EVD. In group B we found an infection rate of the CSF in 10% of the patients, and 12% regarding the evd. The trend towards less infections is evident, even though it is statistically not significant (p=0,49; chi-squared-test). In group B we did not observe multi-resistant strains in the microbiological cultures (defined as Oxacillin-resistant strains, ORSA), which were found in group A in one case.

Conclusions

The prophylatic use of antibiotics in the treatment with EVD did not reduce the CSF infection rate. In contrast, we found a trend towards less infections in the non-antibiotics group. Multi-resistant germ strains were only found in the group of patients with continous prophylactic antibiotics. The continuous prophylactic use of antibiotics can therefore no longer be recommended, not only because of the development of multi-resistant strains, but also in respect to economic aspects regarding the cost of antibiotics.