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62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

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Silver impregnated external ventricular drains reduce the incidence of CSF infection and the need for post-EVD shunt placement: results of the SILVER trial

Meeting Abstract

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  • N.C. Keong - Academic Neurosurgery Division, Department of Clinical Neurosciences, Addenbrooke’s Hospital, Cambridge
  • D.O. Bulters - Wessex Neurological Centre, Southampton
  • H. Richards - Academic Neurosurgery Division, Department of Clinical Neurosciences, Addenbrooke’s Hospital, Cambridge
  • M. Farrington - Department of Microbiology, Cambridge
  • O.C. Sparrow - Wessex Neurological Centre, Southampton
  • J.D. Pickard - Academic Neurosurgery Division, Department of Clinical Neurosciences, Addenbrooke’s Hospital, Cambridge
  • P.J. Hutchinson - Academic Neurosurgery Division, Department of Clinical Neurosciences, Addenbrooke’s Hospital, Cambridge
  • P.J. Kirkpatrick - Academic Neurosurgery Division, Department of Clinical Neurosciences, Addenbrooke’s Hospital, Cambridge

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocMO.03.01

doi: 10.3205/11dgnc001, urn:nbn:de:0183-11dgnc0010

Published: April 28, 2011

© 2011 Keong et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: The SILVER (Silver Impregnated Line Versus EVD Randomised) trial is a randomised double-blinded controlled trial designed to evaluate the effectiveness of silver impregnation on CSF infection rates after insertion of an external ventricular catheter (EVD).

Methods: Patients satisfying strict inclusion criteria were randomised to receiving either a silver impregnated EVD (Spiegelberg ((GmbH & Co.) KG, Tempowerkring 4, 21079 Hamburg, Germany), or a plain catheter. Both were colour coded as part of the blinding process and constructed to look identical. Routine CSF sampling was performed and sent for microscopy, culture and sensitivity. CSF samples were collected at least every 72 hours whilst the catheter remained in place. Primary (CSF infection rate) and secondary (duration of EVD placement, number of revisions, requirement for shunts, total duration from admission to discharge and Glasgow Coma Scale (GCS) on discharge) end points were assessed.

Results: Data from 278 patients were available for analysis (plain arm =140, silver arm =138). The overall infection rate was 16.9 % (47/278); 21.4% (30/140) for plain and 12.3% (17/138) for silver EVD (p=0.042). The silver arm had a consistently lower infection risk throughout the interim analysis period, and demonstrated a different time to infection profile. In addition, patients with EVDs who suffered a catheter-related CSF infection had more than double the risk of requiring a later shunt insertion (44.7%), particularly if the EVD had demonstrated infection (53.3% vs. 29.4% conversion rate).

Conclusions: The SILVER trial represents the first class I evidence of a benefit of one type of EVD over another in terms of infection rate. Secondary benefits were seen in subsequent shunt conversion rate, which represents a significant positive health care benefit.