Do antibiotic-impregnated shunts in hydrocephalus therapy reduce the risk of infection? An observational study in 258 patients

Ritz, Rainer; Röser, Florian; Morgalla, Matthias; Dietz, Klaus; Tatagiba, Marcos; Will, B.

doi:10.1186/1471-2334-7-38

Cited by 97 publications

(54 citation statements)

References 34 publications

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“…Although 2 earlier studies did not find any effect on infection rates from AIS catheter use, 11,21 larger studies, including meta-analyses, have reported a reduction largely in line with that reported in the present study. 2,[7][8][9][10][12][13][14][15][16][17]20,22,24,28 This study supports previous recommendations made in favor of universal adoption of AISs.…”

Section: Discussionsupporting

confidence: 87%

“…2,[7][8][9][10][11][12][13][14][15][16][17][20][21][22]24,28 These studies are somewhat heterogeneous in terms of follow-up, patient population (pediatric only, adult only, or mixed), whether primary insertion only or revision surgeries also were included, and in reporting of causative pathogens. Some recent studies have highlighted the possibility of AIS catheters promoting selection of antibiotic-resistant organisms.…”

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confidence: 99%

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Effect of introduction of antibiotic-impregnated shunt catheters on cerebrospinal fluid shunt infection in children: a large single-center retrospective study

James¹,

Hartley

Morgan³

et al. 2014

PED

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Object Infection after both primary and revision shunt surgeries remains a major problem in pediatric neurosurgical practice. Antibiotic-impregnated shunt (AIS) tubing has been proposed to reduce infection rates. The authors report their experience with AIS catheters in their large pediatric neurosurgery department. Methods The authors conducted a retrospective case review of consecutive shunt operations performed before (1993–2003) and after (2005–2009) introduction of AIS tubing, with analysis of shunt infection rates and causative organisms identified. Results The historical control group consisted of 1592 consecutive shunt operations (657 primary insertions), and the AIS study group consisted of 500 consecutive shunt operations (184 primary insertions). Patients ranged in age from 0–17 years. In the historical group, 135 infections were identified (8.4%). In the AIS study group, 25 infections were identified (5%), representing a significant reduction (p < 0.005). The latency to diagnosis of infection was 23 days in the historical group and 139 days in the AIS study group. The infection rates in infants 0–6 months of age were 12.2% (historical group) and 6.7% (AIS group, p < 0.005), and in infants 7–12 months of age the rates were 7.9% (historical group) and 2.7% (AIS group, p < 0.005). In the historical control group, the frequency rank order of causative organisms was coagulase-negative staphylococcus (51.9%), Staphylococcus aureus (31.6%), streptococcus or enterococcus spp. (8.8%), gram-negative organisms (4.4%), and Propionibacterium acnes (2.2%). Organisms responsible for infections in AIS were S. aureus (40%), followed by streptococcus or enterococcus spp. (20%), P. acnes and coagulase-negative staphylococcus (both 16%), and gram-negative organisms (4%). No unusually antibiotic-resistant bacteria were identified in either group. The authors further subdivided the AIS group into those undergoing primary AIS insertion (Subgroup 1), those undergoing revision of non-AIS systems using AIS components (Subgroup 2), and those undergoing revision of AIS systems using AIS components (Subgroup 3). Infection rates were 1.6% in Subgroup 1, 2.5% in Subgroup 2, and 11.7% in Subgroup 3. Staphylococcus aureus was the most common organism identified in infections of the Subgroups 2 and 3. Conclusions Use of AIS tubing significantly improves shunt infection rates in both general pediatric and infant populations with no evidence of increased antibiotic resistance, which is in agreement with previous studies. However, the increased infection rate in revision surgery in children with AIS catheters in situ raises questions about their long-term application.

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Section: Discussionsupporting

confidence: 87%

mentioning

confidence: 99%

Effect of introduction of antibiotic-impregnated shunt catheters on cerebrospinal fluid shunt infection in children: a large single-center retrospective study

James¹,

Hartley

Morgan³

et al. 2014

PED

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“…There is weak evidence that antibiotic-impregnated catheters can reduce the rate of shunt infection, 8,17,23 although the results are mixed. 10,19 An ongoing study of a shunt surgery infection protocol has initial promising results, and is one of the many strategies that are needed to reduce the incidence of shunt infection.…”

Section: Discussionmentioning

confidence: 99%

Prospective surveillance of complications in a pediatric neurosurgery unit

Drake

Riva-Cambrin

Jea

et al. 2010

PED

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Object Complications of specific pediatric neurosurgical procedures are well recognized. However, focused surveillance on a specific neurosurgical unit, for all procedures, may lead to better understanding of the most important complications, and allow targeted strategies for quality improvement. Methods The authors prospectively recorded the morbidity and mortality events at a large pediatric neurosurgical unit over a 2-year period. Morbidity was defined as any significant adverse outcome or death (for obstructive shunt failure, within 30 days). Multiple and unrelated complications in the same patient were recorded as separate events. Results There were 1082 surgical procedures performed during the evaluation period. One hundred seventy-seven complications (16.4%) occurred in 147 patients. By procedure, the most common complications occurred in vascular surgery (41.7%) and brain tumor surgery (27.9%). The most common complications were CSF leakage (31 cases), a new neurological deficit (27 cases), early shunt or endoscopic third ventriculostomy obstruction (27 cases), and shunt infection (24 cases). Meningitis occurred in 19 cases: in 58% of shunt infections, 13% of CSF leaks, and 10% of wound infections. Sixty-four percent of adverse events required a second procedure, most commonly an external ventricular drain placement or shunt revision. Conclusions Complications in pediatric neurosurgical procedures are common, result in significant morbidity, and more than half the time require a repeat surgical procedure. Targeted strategies to prevent common complications, such as shunt infections or CSF leaks, might significantly reduce this burden.

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“…Se han identifi cado diversos factores del paciente y de la atención asociados a una infección de DVP 14 . Entre los factores relacionados con el paciente destacan: prematurez 15 , edad menor de cuatro meses, diagnóstico antenatal de hidrocefalia 16 , enfermedad sistémica concomitante 17 , requerimientos previos de derivativa ventricular externa (DVE), estado de conciencia alterado y uso de terapia oncológica adyuvante (quimioterapia y radioterapia) 15 . También debemos considerar dentro de este grupo la etiología de la hidrocefalia, la cual pudiese llegar a ser un factor predictor en sí mismo de la infección de derivativa.…”

Section: Recibido: 21 De Marzo De 2011unclassified

“…Infecciones Asociadas a Atención de Salud tiempos operatorios prolongados 15,20 y el rasurado de la piel a intervenir 21,22 . Otros factores neuroquirúrgicos identifi cados son: presencia de una fístula de LCR, craneotomía, hipertensión endocraneana (presión intracraneal > 20 mmHg), ventriculostomía de duración prolongada (particularmente en los primeros 7 a 10 días), irrigación del sistema y recambio valvular a repetición 9,17 .…”

Section: Artículo Originalunclassified

Factores de riesgo de infección de derivativa ventrículo peritoneal en pacientes pediátricos del Hospital Carlos Van Buren

et al. 2012

Rev. chil. infectol.

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Hydrocephalus is a common problem in Neurosurgery and Neurology. The usual treatment is the installation of a Ventricular Peritoneal Shunt (VPS). Infection is the most frequent and serious complication. With the aim to identify risk factors associated with infection in the post surgery of VPS in pediatric patients from Carlos Van Buren Hospital a case control study between 1998-2008 was done. Cases were patients with VPS infection reported to the Department of Nosocomial Infections. Results in contingency tables were analyzed to determine Odds Ratio. 264 surgical procedures were studied in 207 patients with 53 infections reported in 26 patients. Signifi cant risk factors were: history of prior ventriculitis, VPS dysfunction and prior external ventricular shunt, concurrent infections at the time of surgery and a neurosurgeon without the specialty of pediatric neurosurgery. We concluded that antibiotic prophylaxis was not an important factor in preventing infection and the neurosurgeon experience is relevant to the development of VPS infections.Key words: VPS, infection, risk factors, ventriculitis, shunt infections. Palabras clave: DVP, infección, factores de riesgo, ventriculitis, infección DVP.Universidad de Valparaíso, Valparaíso, Chile. Facultad de Medicina (APA, RSZ, RVF).Hospital Carlos Van Buren, Valparaíso, Chile. Servicio de Neurocirugía. (RRP, CSZ). Departamento de Control de infecciones (RHO).Los autores declaran no tener conflictos de interés. Fuente de financiamiento:Autónoma. Recibido: 21 de marzo de 2011Aceptado: 13 de octubre de 2011Correspondencia a:Introducción L a hidrocefalia es un problema común en neurología y neurocirugía pediátrica, cuya etiología es un desbalance entre la producción, circulación y reabsorción del líquido cefalorraquídeo (LCR)1 . El desarrollo de esta condición en la infancia es frecuente, siendo secundaria a un grupo variado de patologías cerebrales, entre las cuales destacan: cerebrales congénitas, traumáticas, tumorales, infecciosas y vasculares 2 . Una de las opciones para el tratamiento permanente de esta patología es la inserción de un catéter junto a una válvula que conecte el ventrículo cerebral con una cavidad serosa como el peritoneo 3 o derivativa ventrículo peritoneal (DVP) o con una vena profunda, donde el exceso de LCR pueda ser drenado.Se estima que entre 25 y 46% de las derivaciones tienen un mal funcionamiento durante el primer año después de haber sido instaladas 4,5 , siendo la obstrucción mecánica y las infecciones, las dos principales causas de disfunción valvular 6,7 . La tasa de infección post instalación de DVP en la población infantil se estima en 10% y fl uctúa entre 0 y 22% [8][9][10][11] , siendo una causa importante de morbimortalidad 12 . Las infecciones tempranas son causadas por la microbiota bacteriana introducida al momento de la cirugía, mientras que las tardías corresponden a contaminaciones posteriores 13 . Se han identifi cado diversos factores del paciente y de la atención asociados a una infección de DVP 14 . Entre los factores relac...

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Do antibiotic-impregnated shunts in hydrocephalus therapy reduce the risk of infection? An observational study in 258 patients

Cited by 97 publications

References 34 publications

Effect of introduction of antibiotic-impregnated shunt catheters on cerebrospinal fluid shunt infection in children: a large single-center retrospective study

Effect of introduction of antibiotic-impregnated shunt catheters on cerebrospinal fluid shunt infection in children: a large single-center retrospective study

Prospective surveillance of complications in a pediatric neurosurgery unit

Factores de riesgo de infección de derivativa ventrículo peritoneal en pacientes pediátricos del Hospital Carlos Van Buren

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