Background External ventricular drainage (EVD) is a critical neurosurgical procedure for managing intracranial hypertension and hydrocephalus, yet it carries a substantial risk of cerebrospinal fluid (CSF) infections, affecting up to 9% of cases. Antibiotic-impregnated (AI) EVD catheters have been developed to mitigate catheter-related infections by reducing bacterial colonization. This pilot study aimed to compare infection rates between AI and standard EVD catheters in a real-world clinical setting. Methods All EVD procedures performed between January 1, 2024, and June 30, 2025, at a single tertiary neurosurgical center were prospectively registered. Patients were assigned to AI (Bactiseal®) or standard catheters based on clinician preference and availability. Infection was defined as (1) proven: positive CSF culture with positive Gram stain; or (2) suspected: (A) positive CSF culture without initial Gram stain organisms; (B) negative CSF culture with gram-positive/negative stain; or (C) CSF leukocytosis with white blood cell/red blood cell ratio >0.02. Demographic, procedural, and outcome data were analyzed using Fisher’s exact test and Student’s t-test. Results Eighty-eight patients (40 AI, 48 standard) were included. Baseline characteristics were comparable between groups. Proven infections occurred in 12 patients (13.6%; AI: 4 [10.0%], standard: 8 [16.7%]; P=0.37). Suspected infections were noted in 18 patients (20.5%; AI: 4 [10.0%], standard: 14 [29.2%]; P=0.03). Overall complication rates were low, with no significant differences in duration of catheterization (AI: 7.2 ± 3.1 days vs. standard: 6.8 ± 2.9 days; P=0.52) or other adverse events. Pathogen analysis revealed gram-positive dominance (e.g., Staphylococcus epidermidis in 58.3% of proven cases). Conclusion In this pilot study, AI-EVD catheters demonstrated numerically lower proven and significantly reduced suspected infection rates compared to standard catheters. AI catheters appear safe and may offer a protective effect against suspected infections, warranting larger randomized trials to confirm efficacy.

Antibiotic-impregnated, Cerebrospinal fluid infection, External ventricular drainage, Ventriculostomy, Hydrocephalus.