To assess the efficacy of antimicrobial-impregnated
catheters in preventing
catheter-related infections during external ventricular drainage (EVD), we performed a meta-analysis and systematic review. We systematically searched Medline, Embase, and the Cochrane Library. All randomized controlled trials (RCTs) and nonrandomized prospective studies (NPSs) related to antimicrobial-impregnated EVD
catheters were included. The primary outcome was the rate of cerebrospinal fluid
infection (
CFI). The secondary outcomes included the rate of time-dependent
CFI and
catheter bacterial colonization. We further performed subgroup analysis, meta-regression analysis, and microbial spectrum analysis. Four RCTs and four NPSs were included. The overall rate of CFIs was 3.6% in the antimicrobial-impregnated
catheter group and 13.7% in the standard
catheter group. The pooled data demonstrated that antimicrobial-impregnated
catheters were superior to standard
catheters in lowering the rate of CFIs (odds ratio (OR) = 0.25, 95% confidence interval (CI) = 0.12 to 0.52, P <0.05). In survival analysis, the 20-day
infection rate was significantly reduced with the use of antimicrobial-impregnated
catheters (hazard ratio = 0.52, 95% CI = 0.29 to 0.95, P <0.05). Furthermore, a significantly decreased rate of
catheter bacterial colonization was noticed for antimicrobial-impregnated
catheters (OR = 0.37, 95% CI = 0.21 to 0.64, P <0.05). In subgroup analyses, although significant results remained for RCTs and NPSs, a subgroup difference was revealed (P <0.05). Compared with standard
catheters, a significantly lower rate of CFIs was noticed for
clindamycin/
rifampin-impregnated
catheters (OR = 0.27, 95% CI = 0.10 to 0.73, P <0.05) and for
minocycline/
rifampin-impregnated
catheters (OR = 0.11, 95% CI = 0.06 to 0.21, P <0.05). However, no statistical significance was found when compared with
silver-impregnated
catheters (OR = 0.33, 95% CI = 0.07 to 1.69, P = 0.18). In microbial spectrum analysis, antimicrobial-impregnated
catheters were shown to have a lower rate of
Gram-positive bacterial infection, particularly the
coagulase-negative Staphylococcus. In conclusion, the use of antimicrobial-impregnated EVD
catheters could be beneficial for the prevention of
CFI and
catheter bacterial colonization. Although
antibiotic-coated
catheters seem to be effective, no sufficient evidence supports the efficacy of
silver-impregnated
catheters.