Determinants and Outcomes of Ventriculoperitoneal Shunt Infections in Enugu, Nigeria

Abstract

Background: To evaluate the determinants and outcomes of shunt infection (SI). Methods: One hundred ninety-eight pediatric hydrocephalic patients treated with a ventriculoperitoneal (VP) shunt between January 2008 and August 2012 were retrospectively studied. Patients with SI were compared to those without SI in terms of the occurrence of risk factors and outcomes. Data was analyzed using Statistical Package for the Social Sciences software (version 15). Results: The age range was 2 weeks to 13 years, with a mean age of 3.1 ± 0.19 years for the SI group versus 2.7 ± 0.2 years for those without SI. One hundred and twelve patients were female and 86 were male. SI was recorded in 17 (8.6%) patients. Postinfective hydrocephalus (n = 6) was the most common cause of hydrocephalus in the SI group. Individuals in the SI group, compared to those without infection, were more likely to be underweight (χ² = 23.4, p < 0.01). The mean interval between VP shunt placement and SI was 1.83 ± 1.25 months. Coagulase-negative Staphylococcus (29.4%) was the most common pathogen. The mortality rate in our series was 21.4% in patients with SI compared to 2.7% in those without SI. Conclusion: Coagulase-negative Staphylococcus is currently the most common cause of SI and underweight children appear have a higher risk.

Congenital Hydrocephalus

“…In this study the mean interval between shunt placement and infection was 1.83 AE 1.25 months and coagulasenegative Staphylococcus was the most commonly encountered pathogen. 31 In a human study of 333 consecutive ventriculoperitoneal shunts placed in pediatric patients, it was found that 35 shunts (10.5%) were infected and that infection occurred at a median of 1 months after shunt placement. 32 As in the previously mentioned study, the most common causative agent was coagulase-negative Staphylococcus.…”

Challenges and outcome of cranial neuroendoscopic surgery in a resource constrained developing African country

“…Low infection rates have also been reported by other authors. [22,23] When compared to the shunt sepsis rate of 8.6% from our recently published article, [24] the low ETV sepsis makes this option a particularly attractive choice in our low-income environment. We performed aqueductal membrane fenestration (aqueductostomy) without ETV in 3 patients with membranous aqueductal stenosis.…”

Review of Clinically and Epidemiologically Relevant Coagulase-Negative Staphylococci in Africa

“…CoNS were the most common etiology (29.4%), ahead of S. aureus (23.5%) and Escherichia coli (11.8%) in a study conducted to investigate the contributing factors and outcomes of shunt infection in Nigeria (Table 1). 72 Shunt infection was defined in the study as positive cerebrospinal fluid (CSF) with positive shunt component culture. Ventriculoperitoneal (VP) shunt is the main surgical procedure used in the treatment of hydrocephalus.…”

“…However, the increase in VP-associated infections has caused significant morbidity and mortality in VP-treated hydrocephalic children, with the skin mostly the source of infection. 72 The early detection and swift initiation of therapy are critical in the success of treatment of infections associated with VP shunts. The findings of the study agreed with general literature that CoNS and S. aureus are the most commonly reported causes of shunt infections.…”

“…Of significant note was that the mortality rate in patients with shunt infection was 21.4% as compared with 2.7% in those without shunt infection. 72 Treatment of CoNS in invasive device-related infections has been discussed under ''treatment'' section.…”