2026 Eastern States Conference

Authors: John Kim, PharmD; Daniel Abate, PharmD; Alexander Walk, PharmD, MS, AAHIVP 

Learning Objective: Describe the role of antibiotic prophylaxis in patients requiring placement of a cerebrospinal fluid (CSF) drain 

Self-Assessment Question: True or False
Current IDSA guidelines recommend against the use of prolonged antibiotic prophylaxis for EVDs

Background 
There is no clear evidence regarding the use of prolonged antibiotic prophylaxis in patients requiring a CSF drain placement. The objective is to evaluate the efficacy and safety of antibiotic prophylaxis in these patients. 

Methods  
This will be a retrospective cohort study that will analyze adult patients at Suburban Hospital Johns Hopkins Medicine that require a lumbar drain, external ventricular drain, or ventriculoperitoneal shunt placement between 05/01/2015 and 08/01/2025. Exclusion criteria will include patients with central nervous system infection upon admission, history of Clostridioides difficile (C. diff) infection on admission, and those with an existing CSF drain prior to admission. The primary efficacy outcome will be the incidence of infection post-operatively and the primary safety outcome will be the development of C.diff infection 

Results 
For the primary efficacy outcome, 4.2% of the patients or 3/72 (0.87-11.7) developed infection post-operatively. For the primary safety outcome, 1.4% of the patients or 1/72 (0.03-7.5) developed C.diff infection. 26/27 patients with EVDs were administered prolonged antibiotics. 2/45 patients with VP shunts were administered prolonged antibiotics. 

Conclusion 
At Suburban Hospital Johns Hopkins Medicine patients with EVDs and VP shunts have low rates of post-operative and C. diff infection. Prolonged antibiotic use is most prevalent with placement of EVDs compared to VP shunts. The efficacy and safety of prolonged antibiotic use remain uncertain Future trials that include a comparator group and focus on EVDs may provide stronger evidence to support guideline recommendations