Medical Student University of Miami Miller School of Medicine Miami, Florida, United States
Introduction: Ventriculostomy-associated infections (VAI) are a potential serious complication of external ventricular drains (EVD). Antibiotics are commonly used as prophylaxis against VAIs, however, the efficacy of this practice is not well established. Our study looks at the association of antibiotic prophylaxis with VAIs and other complications patients with EVDs.
Methods: We conducted a multicenter retrospective cohort study of adults (≥18 years-old) within the Premier Healthcare Database (2008-2018) who received mechanical ventilation and placement of an EVD on or before day 3 of hospitalization. Antibiotic prophylaxis was defined as receipt of antibiotics with central nervous system penetration within the first two days of admission. The primary outcome was VAIs (defined as ICD-9/-10 codes for ventriculitis, encephalitis, meningitis, or central nervous abscesses). Logistic and Poisson regression models were created to identify independent associations of antibiotic prophylaxis with outcomes including age, sex, race, insurance status, hospital type, Elixhauser comorbidities, major surgery, and renal replacement therapy as covariates.
Results: A total of 9,041 (85.3%) patients with and 1,555 (14.7%) without antibiotic prophylaxis were included. The median age was 57 (IQR: 44, 68) years and 41.2% female vs 60 (48, 70) years and 48.9% female in the with and without antibiotics cohorts, respectively, with p< 0.001 for both comparisons. No association was found between antibiotic prophylaxis and VAIs (OR 0.91 [95 confidence interval]: 0.65, 1.29), p= 0.59). Prophylaxis was associated with a higher odds of Clostridioides difficile infection (1.33 [1.11, 1.58], p=0.002), but a lower odds of death by hospital discharge (OR 0.84 [0.75, 0.95], p=0.004). Prophylaxis was not associated with hospital length of stay or home discharge among survivors.
Conclusion : Antibiotic prophylaxis is not associated with decreased VAIs, but is associated with decreased mortality and increased risk of Clostridioides difficile infection. Further studies should be conducted to determine optimal infection prevention for patients with EVDs.
