• Rebecca Thomas, Sharon Lee, Sanjay Patole, and Shripada Rao.
• Princess Margaret Hospital for Children, Perth, Australia.
• Br J Neurosurg. 2012 Apr 1;26(2):175-84.

UnlabelledCSF infections are a serious complication of CSF shunts and external ventricular drains (EVDs). Antibiotic-impregnated catheters (AIC) have been tried in order to minimise the risk of such infections.ObjectivesTo conduct a systematic review and a meta-analysis comparing AICs versus non-AICs used as ventriculo-peritoneal (VP) shunts or external ventricular drains (EVDs) in the neonatal population. The secondary aim was to include data from a paediatric and adult population if insufficient information was available from neonatal studies.Data SourcesPubMed (March 2011), EMBASE (March 2011), CENTRAL (1980-March 2011), and CINAHL (March 2011) were searched. Study selection. Both randomised controlled trials (RCTs) and observational studies were included.ResultsOnly three observational studies reported on the use of AI-VP shunt catheters in the neonatal population. Meta-analysis found a statistically significant difference favouring AI shunts (RR: 0.37; CI: 0.16, 0.86; p = 0.02). Twelve studies (one RCT, 11 observational; n = 3284) compared AI versus non-AI VP shunts in a paediatric and adult population. The RCT showed a trend towards benefit using the AICs (RR: 0.38; 95% CI: 0.11, 1.30; p = 0.12). A meta-analysis of the 11 observational studies showed a significant benefit in the AI group (RR: 0.37; CI: 0.23, 0.60; p = 0.0001; n = 3149). Similar benefits were noted for AI-EVDs in RCTs (RR: 0.19; 95% CI: 0.05, 0.64; p = 0.01; n = 472, two studies) and observational studies (RR: 0.31; 95 CI: 0.13, 0.74; p = 0.009; n = 2415, five studies).ConclusionsA meta-analysis of mainly observational studies suggests that AICs may be an effective way of reducing the incidence of shunt and EVD infections. Well-designed multi-centre RCTs are urgently needed.

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