InfectionProphylactic antibiotics with intracranial pressure monitors and external ventricular drains: a review of the evidence
Section snippets
Materials and methods
Meta-analysis is a statistical technique that retrospectively analyzes data collected in previous trials in a precise standardized fashion to resolve uncertainty and increase the statistical power of the prior results 3, 42, 54. It provides useful information in circumstances where a large, randomized, placebo-controlled trial may be precluded due to ethical, financial, or logistic constraints, and where previous smaller studies may not have provided definitive answers or are in conflict with
Results
The literature search yielded only two studies that met the inclusion criteria for meta-analysis 5, 26, 27. Thirty-six other studies were identified that did not meet the inclusion criteria for meta-analysis, but appeared to contain interesting comments about the role of PABs or infections associated with ICP monitors and EVDs 1, 2, 6, 12, 16, 18, 28, 30, 31, 43, 45, 46, 49, 51, 52, 53, 55, 57, 61, 62, 65, 67, 71, 72, 77, 82, 86, 88, 91, 93, 94, 96, 101, 102, 104, 105. Agreement among the
Literature review
Recent reports have proven statistically the usefulness of PABs with craniotomies and CSF shunt surgeries with I.R.s >5% 3, 8, 9, 14, 20, 23, 32, 41, 42, 54, 103. However, conflicting reports are noted in the literature as to whether PABs are beneficial with ICP monitors and EVDs 33, 63. Most of the published studies are retrospective, nonrandomized, nonblinded trials, without adequate controls or patient numbers Table 2, Table 3. Appropriate indications for PABs are not well defined, whereas
Conclusions
The above analysis does not resolve the question regarding the role of PABs with ICP monitors and EVDs. A randomized, placebo controlled, multicenter, double blind study with 500–700 patients could determine the precise role of PABs with these devices 22, 97, 100. Of the centers surveyed 75% expressed interest in participating in such a study.
Because at present there is no proof of the efficacy of PABs with ICP monitors and EVDs, there is no way to be certain that PABs are appropriate. Those
Acknowledgements
The authors thank Joyce Herschberger and Charles Molasky, BS Pharm., for their assistance in preparing this article.
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