The authors conducted a prospective, randomized clinical trial at six academic medical centers. All hospitalized patients 18 years or older who required placement of an EVD
catheter were eligible for inclusion in the study. Patients were randomly assigned to undergo placement of an EVD with a
catheter impregnated with
minocycline and
rifampin or a standard untreated
catheter (control group). To assess primary outcome, CSF samples were collected using a sterile technique at the time of
catheter insertion, at least every 72 hours while the
catheter remained in place, and at the time of
catheter removal. At the time of removal, CSF cultures were obtained from the tip and tunneled segments of each
catheter by performing semiquantitative roll-plate and quantitative sonication techniques. Of the 306 patients enrolled in the study, data from 288 were included in the final analysis. Eighteen patients were excluded from analysis: 14 because the ventricular
catheter was in place less than 24 hours, and four because CSF cultures obtained at the time of
catheter insertion were positive for
infection. Of these 288 patients, 139 were assigned to the control group and 149 to the treatment group. The two groups were well matched with respect to all clinical characteristics, including patient sex and mean age, indication for
catheter placement, and length of time the
catheter remained in place. The
antibiotic-impregnated
catheters were one half as likely to become colonized as the control
catheters (17.9 compared with 36.7%, respectively, p < 0.0012). Positive CSF cultures were seven times less frequent in patients with
antibiotic-impregnated
catheters compared with those in the control group (1.3 compared with 9.4%, respectively, p = 0.002).
CONCLUSIONS: