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1150. Evaluating the Impact of Antibiotic Prophylaxis on the Microbiology and Incidence of Ventriculitis in Patients with External Ventricular Drains

Abstract Background External ventricular drains (EVDs) are frequently used in acute brain injuries for continuous intracranial pressure monitoring and cerebrospinal (CSF) fluid diversion. EVDs are associated with a 0–22% risk of ventriculitis. The evidence for antibiotic prophylaxis (AP) for ventriculitis prevention is not robust. This study aimed to delineate the incidence of EVD-related ventriculitis and causative organisms in patients receiving AP. Methods A retrospective chart review from 2013 to 2018 at Yale New Haven Hospital was performed. Patients were included if ≥18 years of age, admitted to the neurosciences intensive care unit (ICU), and had AP with cefazolin, vancomycin, sulfamethoxazole/trimethoprim, or clindamycin. Patients were excluded if they had a diagnosis of meningitis or ventriculitis prior to EVD placement, on multiple agents for AP, on antibiotics for indications other than AP, CSF leak, or skull fracture. The primary endpoint was the incidence of ventriculitis per 1,000 EVD-days. Secondary endpoints were causative organisms of ventriculitis, EVD duration, ICU length of stay (LOS), hospital LOS, and 30-day mortality. Results Five hundred ninety-nine patients were reviewed and 249 patients were included. Baseline demographics are noted in Table 1. Cefazolin was the most common agent for AP (98%). There were 7 cases of ventriculitis with an incidence rate of 2.8% (4 infections per 1000 EVD-days). All of the causative organisms were resistant to the prophylactic agents administered (Table 2). Patients with ventriculitis had a significantly longer duration of EVD placement (10 ± 3 vs. 7 ± 6 days, P = 0.03), hospital LOS (30 ± 19 days vs. 15 ± 12, P = 0.04), ICU LOS (22 ± 14 vs. 10 ± 7, P = 0.03). Two patients with ventriculitis (28%) died within 30 days of admission compared with 46 patients without ventriculitis (19%, P = 0.53) (Table 3). Conclusion The rate of ventriculitis in our study was similar to previous studies that did not utilize AP. All of the causative organisms were resistant to the prophylactic agent. Patients who had ventriculitis had a longer duration of EVD placement, hospital LOS, and ICU LOS; however, 30-day mortality was not impacted. Based on our findings, the use of AP to prevent EVD-related ventriculitis should be reconsidered. Disclosures All authors: No reported disclosures.

Background. External ventricular drains (EVDs) are frequently used in acute brain injuries for continuous intracranial pressure monitoring and cerebrospinal (CSF) fluid diversion. EVDs are associated with a 0-22% risk of ventriculitis. The evidence for antibiotic prophylaxis (AP) for ventriculitis prevention is not robust. This study aimed to delineate the incidence of EVD-related ventriculitis and causative organisms in patients receiving AP.
Methods. A retrospective chart review from 2013 to 2018 at Yale New Haven Hospital was performed. Patients were included if ≥18 years of age, admitted to the neurosciences intensive care unit (ICU), and had AP with cefazolin, vancomycin, sulfamethoxazole/trimethoprim, or clindamycin. Patients were excluded if they had a diagnosis of meningitis or ventriculitis prior to EVD placement, on multiple agents for AP, on antibiotics for indications other than AP, CSF leak, or skull fracture. The primary endpoint was the incidence of ventriculitis per 1,000 EVD-days. Secondary endpoints were causative organisms of ventriculitis, EVD duration, ICU length of stay (LOS), hospital LOS, and 30-day mortality.
Conclusion. The rate of ventriculitis in our study was similar to previous studies that did not utilize AP. All of the causative organisms were resistant to the prophylactic agent. Patients who had ventriculitis had a longer duration of EVD placement, hospital LOS, and ICU LOS; however, 30-day mortality was not impacted. Based on our findings, the use of AP to prevent EVD-related ventriculitis should be reconsidered.

Disclosures. All authors:
No reported disclosures. Background. Catheter-associated urinary tract infection (CAUTI) is one of the most common nosocomial infections. To date, there have been no randomized controlled studies to recommend the most appropriate antiseptic solution for periurethral cleaning before indwelling urinary catheterization. This study was aimed to compare normal saline solution (NSS) and Savlon solution for periurethral cleaning before indwelling urinary catheterization in reducing catheter-associated bacteriuria.

A Comparison of Periurethral Cleaning Between Normal Saline and Savlon
Methods. A randomized controlled, noninferiority, cross-over study to determine the incidence of significant bacteriuria (SB) on day 5 after Foley catheterization, using 2 different solutions for periurethral cleaning (NSS and Savlon solutions), was carried out in all adult patients admitted in the 2 medical intensive care units (ICUs), 1 surgical ICU, 2 neurosurgical ICUs, 4 medical wards, 4 surgical wards and 1 emergency room (ER) of King Chulalongkorn Memorial Hospital, Thailand, from June 2018 to March 2019. The acceptable prespecified noninferiority margin was set to be 10%. Each solution was used alternately every 3 months in each unit. Urine culture was collected on day 1, 3, and 5 of Foley catheter.
Results. During the study period, there were 207 and 160 patients in the NSS and Savlon groups, respectively. 202 (55%) patients had received Foley catheterization in the emergency room. There were no significant differences in the indication, the current illness, and preexisting condition between the 2 groups. The overall incidence of SB on day 3 and 5 after catheterization was 4% and 8.2%. The incidence of CAUTI was 3.43/1,000 catheter-day. The median duration of catheterization was 5 (IQR 3, 7) days. On day 5 after catheterization, noninferiority was demonstrated for the incidence of SB with an adjusted difference of 4 (95% CI of the difference: −2.1% to 8.9%, P = 0.05). Regarding the incidence of CAUTI, there was no significant difference between the 2 groups.
Conclusion. To the best of our knowledge, our study was the first randomized controlled study to compare the 2 solutions for periurethral cleaning before indwelling urinary catheterization in different departments. This study demonstrates the noninferiority of NSS to Savlon solution in reducing the incidence of SB.