Antimicrobial-impregnated and -coated shunt catheters for prevention of infections in patients with hydrocephalus: a systematic review and meta-analysis

Konstantelias, Athanasios A.; Vardakas, Konstantinos Z.; Polyzos, Konstantinos A.; Tansarli, Giannoula S.; Falagas, Matthew E.

doi:10.3171/2014.12.jns14908

Cited by 90 publications

(61 citation statements)

References 53 publications

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“…If a shunt is still necessary, VP shunts appear to be more preferable to VA or VJ shunts (see Table 7). The use of antibiotic-coated shunts and perioperative antibiotic prophylaxis may play a role in the prevention of shunt infection [79, 80]. …”

Section: Discussionmentioning

confidence: 99%

Delayed Manifestation of Shunt Nephritis: A Case Report and Review of the Literature

Babigumira

Huang

Werner

et al. 2017

Case Reports in Nephrology

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We present an unusual case of shunt nephritis in a 39-year-old male who presented 21 years after placement of a ventriculoperitoneal (VP) shunt. He complained of fevers, headaches, dizziness, and urticarial plaques on arms, trunks, and legs and was found to have anemia, low complement levels, elevated serum creatinine, proteinuria, and new onset microhematuria. Blood and urine cultures were negative. Renal biopsy showed features of acute tubulointerstitial nephritis attributed to vancomycin use. Glomeruli showed increased mesangial hypercellularity and segmental endocapillary proliferation. Immunofluorescence showed focal IgM and C3 staining. Electron microscopy revealed small subendothelial electron-dense deposits. Symptoms and renal insufficiency appeared to improve with antibiotic therapy. He was discharged and readmitted 2 months later with similar presentation. CSF grew Propionibacterium acnes and shunt hardware grew coagulase-negative Staphylococcus. He completed an intravenous antibiotic course and was discharged. On 1-month follow-up, skin lesions persisted but he was otherwise asymptomatic. Follow-up labs showed significant improvement. We did a brief systematic review of the literature on shunt nephritis and report our findings on 79 individual cases. In this review, we comment on the presentation, lab findings, pathological features, and management of this rare, potentially fatal, but curable disease entity.

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Section: Discussionmentioning

confidence: 99%

Delayed Manifestation of Shunt Nephritis: A Case Report and Review of the Literature

Babigumira

Huang

Werner

et al. 2017

Case Reports in Nephrology

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“…35,36 There exists a growing body of evidence in support of antibioticimpregnated ventricular catheters and they are gradually replacing conventional plain silicone catheters in daily practice with considerable cost savings. [37][38][39][40] There are also accompanying concerns about the development of antibiotic-resistant microorganisms and a recent meta-analysis has elucidated the higher risk of Gram-negative and MRSA shunt infections. 38 In this series, only 12 patients received antibiotic-impregnated catheters during the study period so it is difficult to draw any conclusion about their effectiveness.…”

Section: Discussionmentioning

confidence: 99%

Primary ventriculoperitoneal shunting outcomes: a multicentre clinical audit for shunt infection and its risk factors

Woo

Wong

et al. 2016

Hong Kong Med J

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Objectives:To determine the frequency of primary ventriculoperitoneal shunt infection among patients treated at neurosurgical centres of the Hospital Authority and to identify underlying risk factors.Methods: This multicentre historical cohort study included consecutive patients who underwent primary ventriculoperitoneal shunting at a Hospital Authority neurosurgery centre from 1 January 2009 to 31 December 2011. The primary endpoint was shunt infection, defined as: (1) the presence of cerebrospinal fluid or shunt hardware culture that yielded the pathogenic micro-organism with associated compatible symptoms and signs of central nervous system infection or shunt malfunction; or (2) surgical incision site infection requiring shunt reinsertion (even in the absence of positive culture); or (3) intraperitoneal pseudocyst formation (even in the absence of positive culture). Secondary endpoints were shunt malfunction, defined as unsatisfactory cerebrospinal fluid drainage that required shunt reinsertion, and 30-day mortality.Results: A primary ventriculoperitoneal shunt was inserted in 538 patients during the study period. The mean age of patients was 48 years (range, 13-88 years) with a male-to-female ratio of 1:1. Aneurysmal subarachnoid haemorrhage was the most common aetiology (n=169, 31%) followed by intracranial tumour (n=164, 30%), central nervous system infection (n=42, 8%), and traumatic brain injury (n=27, 5%). The mean operating time was 75 (standard deviation, 29) minutes. Shunt reinsertion and infection rates were 16% (n=87) and 7% (n=36), respectively. The most common cause for shunt reinsertion was malfunction followed by shunt infection. Independent predictors for shunt infection were: traumatic brain injury (adjusted Primary ventriculoperitoneal shunting outcomes: a multicentre clinical audit for shunt infection and its risk factorsNew knowledge added by this study • The local rate of infection in ventriculoperitoneal (VP) shunts meets international standards.• Vancomycin antibiotic prophylaxis is a risk factor for shunt infection and is a novel finding.• VP shunt inserted as an emergency procedure is the strongest risk factor for infection. Implications for clinical practice or policy• There is a need to review prophylactic vancomycin administration in terms of timing, dosage, and the need for its combination with another antibiotic.• Emergency VP shunting is not recommended. Shunts should be implanted whenever possible as an elective procedure.• A comprehensive local shunt surgery protocol to reduce the risk of shunt infection is recommended.

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“…They have been the subject of a recent meta-analysis suggesting a reduced infection rate with their use. 8 The cost of care among patients treated with AICs has been reported to be lower. 4 In these data, the patients receiving AICs were compared with patients who did not receive them.…”

Section: Discussionmentioning

confidence: 99%

A new Hydrocephalus Clinical Research Network protocol to reduce cerebrospinal fluid shunt infection

Kestle

Holubkov

Cochrane

et al. 2016

PED

118

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OBJECT In a previous report by the same research group (Kestle et al., 2011), compliance with an 11-step protocol was shown to reduce CSF shunt infection at Hydrocephalus Clinical Research Network (HCRN) centers (from 8.7% to 5.7%). Antibiotic-impregnated catheters (AICs) were not part of the protocol but were used off protocol by some surgeons. The authors therefore began using a new protocol that included AICs in an effort to reduce the infection rate further. METHODS The new protocol was implemented at HCRN centers on January 1, 2012, for all shunt procedures (excluding external ventricular drains [EVDs], ventricular reservoirs, and subgaleal shunts). Procedures performed up to September 30, 2013, were included (21 months). Compliance with the protocol and outcome events up to March 30, 2014, were recorded. The definition of infection was unchanged from the authors' previous report. RESULTS A total of 1935 procedures were performed on 1670 patients at 8 HCRN centers. The overall infection rate was 6.0% (95% CI 5.1%–7.2%). Procedure-specific infection rates varied (insertion 5.0%, revision 5.4%, insertion after EVD 8.3%, and insertion after treatment of infection 12.6%). Full compliance with the protocol occurred in 77% of procedures. The infection rate was 5.0% after compliant procedures and 8.7% after noncompliant procedures (p = 0.005). The infection rate when using this new protocol (6.0%, 95% CI 5.1%–7.2%) was similar to the infection rate observed using the authors' old protocol (5.7%, 95% CI 4.6%–7.0%). CONCLUSIONS CSF shunt procedures performed in compliance with a new infection prevention protocol at HCRN centers had a lower infection rate than noncompliant procedures. Implementation of the new protocol (including AICs) was associated with a 6.0% infection rate, similar to the infection rate of 5.7% from the authors' previously reported protocol. Based on the current data, the role of AICs compared with other infection prevention measures is unclear.

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Antimicrobial-impregnated and -coated shunt catheters for prevention of infections in patients with hydrocephalus: a systematic review and meta-analysis

Cited by 90 publications

References 53 publications

Delayed Manifestation of Shunt Nephritis: A Case Report and Review of the Literature

Delayed Manifestation of Shunt Nephritis: A Case Report and Review of the Literature

Primary ventriculoperitoneal shunting outcomes: a multicentre clinical audit for shunt infection and its risk factors

A new Hydrocephalus Clinical Research Network protocol to reduce cerebrospinal fluid shunt infection

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