Most of us rely on CSF cultures to gauge our treatment of shunt infection. There is variation in the details of individual practice,1 but the decision that the antibiotics have done their job, and that it is safe to replace the shunt is usually based on CSF cultures from the external ventricular drain (EVD).
Six years ago, a randomized trial in adults demonstrated a reduced incidence of infection when antibiotic-impregnated (AI) EVDs were used.3 In that trial the intent was to prevent infection, not treat it. Known or suspected infections were specifically excluded. Since then, AI
StevensEAPalavecinoELSherertzRJShihabiZKCoutureDE: Effects of antibiotic-impregnated external ventricular drains on bacterial culture results: an in vitro analysis. Laboratory investigation. J NeurosurgPublished online December 4 2009; DOI: 10.3171/2009.10.JNS09565