To compare the risk of ventriculostomy-related infection (VRI) according to the type of external ventricular drain (EVD) used [bolt-connected silver-coated EVD (antimicrobial effect) vs tunnelled antibiotic-impregnated EVD]; and determine which catheter is superior. The secondary endpoint was to estimate the risk of infection depending on duration of ventriculostomy.

Prospective single-centre cohort study. All patients who underwent EVD placement between January 2022 and August 2024 were included. Infection was the primary endpoint. Cox regression analysis was used to determine the hazard ratio (HR) depending on the type of catheter, adjusting for possible confounding covariables. Kaplan–Meier curves were used to estimate the cumulative risk of infection.

Ninety procedures were analysed. The overall infection rate was 7.8%. A significantly higher risk of infection was confirmed when tunnelled antibiotic-impregnated catheters were used compared with bolt-connected silver-coated drains after adjusting for placement setting and duration of ventriculostomy [HR 7.61, 95% confidence interval (CI) 1.30–44.38; P =0.024]. Placement of the device in the intensive care unit (ICU) was independently associated with a higher risk of infection compared with placement in the operating room (HR 8.16, 95% CI 1.17–56.94; P =0.034). The risk of VRI was 0% by day 5 (i.e. 5 days after EVD placement), 1.6% by day 10, and 23.5% by day 30.

Bolt-connected silver-coated catheters (antimicrobial coating and skull anchoring) were associated with an 88% lower risk of VRI compared with subcutaneous tunnelled antibiotic-impregnated catheters. Drain placement in the ICU was associated with a higher risk of infection compared with placement in the operating room. The risk of VRI was 0% by day 5 and 1.6% by day 10.