Objectives: To investigate the in vitro antibacterial activity of silver-processed catheters for use in neurosurgery using clinically predictive tests.
Methods: The antimicrobial activity of a commercially available silver-processed external ventricular drain catheter was evaluated against Staphylococcus epidermidis, methicillin-resistant Staphylococcus aureus (MRSA), Escherichia coli and Propionibacterium acnes. Non-impregnated catheters were used as controls. Two assays were performed: (i) testing the ability of the catheter to kill 100% of the attached bacteria (tK100); and (ii) in vitro challenge to determine the ability to prevent colonization under flow conditions. High and low inocula (10(4) and 10(7) cfu/mL) were used. Silver-processed and control catheters were examined by scanning electron microscopy and focused ion beam scanning electron microscopy; electron back-scatter and energy-dispersive X-ray analyses were used to investigate the distribution of silver within the processed catheter.
Results: The silver-processed catheters were not able to kill any of the bacteria tested in the tK100 assay at high inoculum. At low inoculum S. epidermidis was eradicated and some activity was seen against E. coli but without complete eradication. MRSA was also not eradicated even at low inoculum. The in vitro challenge test showed no prevention of colonization for any of the strains. Silver particles were shown to be >500 nm in size.
Conclusions: The commercial silver-impregnated catheter was not able to eradicate MRSA or E. coli and while it showed activity against S. epidermidis in one assay it was unable to prevent colonization in vitro under in-flow conditions. This is consistent with clinical studies on silver-processed catheters.