Does Age or other Factors Influence the Incidence of Ventriculoperitoneal Shunt Infections?

Abstract

Some studies indicate that infants, especially those less than 1 month of age have a higher incidence of ventriculoperitoneal shunt infections. To look at age as well as other variables that might relate to the rate of shunt infection, we reviewed the records of all patients undergoing a ventriculoperitoneal shunt insertion or revision at our institution from January 1, 1985, to December 31, 1994. There were a total of 2,325 ventriculoperitoneal shunting procedures performed on 1,193 patients with a male:female ratio of 678:515. The overall infection rate was 3.2% (74 infections). Analyzed by age, the infection rates were as follows: <1 month 9/223 (4.0%), 1–6 months 16/449 (3.6%), 6–12 months 13/297 (4.4%), 12–18 months 3/122 (2.5%), 18–24 months 7/116 (6.0%) and 24+ months 26/1,118 (2.3%). There was no statistically significant difference between age groups (p > 0.05). Upon selectively examining premature neonates who developed hydrocephalus secondary to intraventricular hemorrhage from the figures given above, one finds that 2/44 (4.5%) of neonates became infected, which was also not significant. The infection rate was the same irrespective of whether the procedure was to insert or revise the shunt, or whether another operative procedure was done under the same anesthesia. The etiology of the hydrocephalus was not a factor, nor was the presence of an open neural tube defect. The presence of fluid accumulation along the shunt tract or at another neurological operative site was associated with a significant increase in incidence of infection 15/168 (8.9%) when compared to those with no fluid accumulation (p < 0.001). The type of infecting organism was divided roughly in thirds, with relatively equal representation from Staphyloccocus epidermidis/coagulase negative and Staphylococcus aureus. The remaining third was comprised of a wide variety of organisms.

Infections of external ventricular drainages

“…This result is in concordance with the findings of other studies, which disputed their effect on higher infection rate [12][13][14].…”

Reduction in CSF shunt infection over a 10-year period associated with the application of concentrated topical antibiotic powder directly to surgical wounds prior to closure

“…The published evidence on this factor is inconsistent, with some studies showing an increase in infection and others showing no difference. 11,21,24,26 Our results showed that any history of prematurity had a weak association with infection, but surgery within 90 days after premature birth did not correlate with shunt infection. We defined health insurance as "private" and "not private."…”

“…34,47 Similarly, studies have shown conflicting associations with age at the time of surgery. Some studies have seen no difference in infection rates based on age (comparing < 1 month, 1-6 months, 6-12 months, 12-18 months, and > 24 months, or comparing "neonate," "infant," "child," and "adult") 7,11,47 and others show increased risk with younger age (varying from less than 4 months to less than 11.3 years). 13,34,36,43,49,50 Although our infection group tended to be younger, age was not found to be a statistically significant predictor of infection.…”

“…7,11,18,21,23,24,31,34,35,40,47 Shunt infection causes significant morbidity for patients, including prolonged hospitalization, repeated surgery, lengthy exposure to antibiotics, increased deaths, and possible intellectual consequences. 34 The economic impact of hydrocephalus and associated shunt failure or infection exceeds a billion dollars annually in the US.…”

Spinal Anesthesia in Infant with Ventriculoperitoneal Shunt: A Case Report of Inguinal Hernia Repair

“…One of the most important VPS complication is VPS infection, with an infection rate as high as 38% and four-fold increase rate in premature neonates [11] [12]. The most common pathogens involved are Staphylococcus epidermidis, Staphylococcus aureus and GRAM negative bacteria [12] [13]. Although no controlled studies show a significant decreasing infection rate with antibiotic prophylaxis, meta-analysis and experts opinion suggest perioperative antibacterial prophylaxis, particularly targeted on Staphylococcus spp.…”