Artikel
SiLuDrain (silver-coated lumbar Drainage) Trial: Results from a prospective randomized study
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Autoren
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Martin Jakobs
- Neurochirurgische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
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Sabrina Klein
- Medizinische Mikrobiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
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Oliver Sakowitz
- Klinik für Neurochirurgie, Klinikum Ludwigsburg, Ludwigsburg, Deutschland
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Andreas Unterberg
- Neurochirurgische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| Veröffentlicht: | 9. Juni 2017 |
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Gliederung
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Objective: The use of silver coated external ventricular drainages has been shown to reduce the number of CSF infections. So far, no data for silver coated lumbar drainages is available. We present first results from a prospective, randomized, monocentric trial reporting on the number of catheter associated infections, catheter handling and complications.
Methods: N=48 patients with an indication for temporary lumbar CSF drainage were enrolled. Patients were randomly allocated (1:1) to receive silver coated or otherweise comparable regular lumbar drainage catheters. Physicians assessed the handling of the systems via a questionnaire. Device related infections (>100 colony forming units on the catheter, positive CSF culture) as well as catheter associated complications were prospectively recorded.
Results: Mean duration of lumbar drainage placement was equal in both groups (4.4 days). Physicians rated the handling of the silver coated lumbar drainages to be significantly superior to the regular ones (p=0.004). There were significantly less (p=0.04) device-related complications (disconnection, dislocation or occlusion) in patients with silver coated lumbar drainages. One device-related infection occurred in the group with silver coated drainages, whereas four infections occurred in the control group with non-coated catheters (p=0.15). In all cases of infection, staphylococci were identified (staph. epidermidis, staph. haemolyticus, staph hominis) as pathogens. Combined adverse events (infections and device related complications) were significantly lower in the group with silver-coated lumbar drainages (p=0.02)
Conclusion: A significant reduction of catheter-associated infections by using silver coated lumbar drainages could not be shown in our prospective, randomized sample of 48 patients. Although the number of infections was four vs. one in favour of the silver coated catheters, a larger sample size is needed to properly assess the hypothesis that silver coated drainages are indeed beneficial to reduce infection rates. However, the significantly lower rate of device-related (non-infectious) complications and adverse events in general already justifies the use of these catheters in patients with an indication for temporary lumbar CSF drainage.
