**7.5 Impregnated EVD catheters**

Two antimicrobial-impregnated EVD catheters have been commercialised and approved for human clinical use. A catheter impregnated with two antimicrobials, rifampicin and minocycline, has been the subject of a prospective randomised controlled trial [53]. They found a significant reduction in ventriculitis (from 36.7 to 17.9%) from plain EVD catheters to impregnated catheters respectively (p = 0.00095). EVD pathogens were mainly *S epidermidis* in the plain catheter group, with gram negative bacteria found in both groups. A study from USA considered the question of whether clinical trial results for this catheter translated into real-life clinical practice. In 113 consecutive patients who received the rifampicin-minocycline impregnated EVD, only one confirmed case of ventriculitis was seen, and this was due to *Enterobacter aerogenes*, against which the catheter offered no protection [88]. The same impregnated catheter was compared with the rifampicin-clindamycin impregnated catheter for EVD in another study but there were no infections in either group [89]. An interesting study comparing rifampicin—clindamycin and rifampicin- minocycline impregnated EVD catheter with plain controls in a sequence of five periods found an infection rate in Period 1 (plain catheters) of 6.7%, Period 2 (plain catheters with procedural changes) 8.2%, Period 3 (rifampicin-clindamycin catheters) 1%, and Period 4 (return to plain catheters) 7.6%, and Period 5 (rifampicin -minocycline catheters) 0.9% [90]. This showed clearly the advantage of both of the commercially available impregnated EVD catheters.
