Initial experience with antibiotic-impregnated silicone catheters for shunting of cerebrospinal fluid in children

Aryan, Henry E.; Meltzer, Hal S.; Park, Min; Bennett, Rebecca; Jandial, Rahul; Levy, Michael L.

doi:10.1007/s00381-004-1052-x

Cited by 103 publications

(44 citation statements)

References 38 publications

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“…Despite their additional cost of $400 to 500, they are used for shorter hospitalization periods as well as to reduce the likelihood of shunt infection by two-thirds. On the other hand, the type of shunt (adjustable, pressurecontrolled, or no-valve) was reportedly unimportant in terms of preventing infection in several studies (1,8,9,14). The surgeon, surgical technique, operating room environment, and operation time were omitted from the analyses in this study.…”

Section: Kanik a Et Al: Aspects Of Vps-related Infectionsmentioning

confidence: 99%

“…In the literature, the average cost of a shunt infection has been reported as 8 to 50,000 US dollars (1,10,11). No studies have investigated the economic aspect of shunt infections in Turkey.…”

Section: Kanik a Et Al: Aspects Of Vps-related Infectionsmentioning

confidence: 99%

“…The incidence of cerebrospinal fluid (CSF) shunt infections varies from 5% to 41% (15). The prevalence of shunt infections has decreased to 10% in recent years as a result of new developments (1,3). Improper treatment of shunt infections results in serious morbidity, mortality, high treatment costs, and psychosocial distress (11).…”

Section: Introductionmentioning

confidence: 99%

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Clinic and economic results of the ventriculoperitoneal shunt infections in children

Kanık¹,

Sirin²,

Köse³

et al. 2014

Turkish Neurosurgery

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AIm: This study evaluated the clinical and economic outcomes of ventriculoperitoneal shunt infections. mATErIAl and mEThOds:Patients diagnosed with ventriculoperitoneal shunt infections for the first time between 1 January 2007 and 31 December 2011 were included in this study. Demographic, clinical, and economic data were analyzed retrospectively. A cost coefficient (total cost/follow-up period) and hospitalization coefficient (duration of hospitalization/follow-up period) were calculated for each patient. rEsulTs:In total, 132 shunt infections (mean follow-up, 734 ± 367 days) were evaluated in 51 patients (mean age, 16.6 ± 9.22 months; median age, 3 months; range, 1-88 months; 28 females, 21 males). In 23 patients (45%), shunt infections were seen in the first 2 months following shunt placement. Seven patients died during the follow-up. There was a negative correlation between the age at diagnosis and the hospitalization duration (p = 0.005, r = -0.381). The average cost of hospitalization per patient was 6397 ± 4338 TL. There was a negative correlation between the cost index and the age at diagnosis (p = 0.04, r = -0.292).CONClusION: Ventriculoperitoneal shunt infections have significant medical and economic impacts. Younger the diagnosis of patients, the hospitalization duration and treatment cost were higher. BulGulAr: Toplam 51 olgudaki (ortalama yaş: 2,58±1,75 ay; ortanca yaş: 3 ay: dağılım aralığı: 1-88 ay; 28 kız / 21 erkek) 132 şant enfeksiyonu (ortalama izlem süresi: 734± 367 gün) değerlendirilmeye alındı. Olguların 23'ünde (%45) ilk enfeksiyon şantın takılmasından sonraki ilk 2 ayda ortaya çıktı. Toplam yedi hasta izlemde kaybedildi. Olguların tanı yaşları ile yatış süresi katsayıları arasında negatif yönde anlamlı bir korelasyon olduğu görüldü (p=0,005; r = -0,381). Bir hasta için yatış başına düşen ortalama maliyet 6397±4338 TL olarak hesaplandı. Bu hastaların maliyet katsayısı ile tanı yaşı arasında negatif yönde anlamlı bir korelasyon saptandı (p=0,04; r = -0,292). sONuÇ: Ventriküloperitoneal şant enfeksiyonları ciddi tıbbi ve ekonomik sonuçlara neden olmaktadır. Hastaların tanı yaşı küçüldükçe hastanede yatış süreleri ve tedavi maliyetleri artmaktadır.

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Section: Kanik a Et Al: Aspects Of Vps-related Infectionsmentioning

confidence: 99%

Section: Kanik a Et Al: Aspects Of Vps-related Infectionsmentioning

confidence: 99%

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Clinic and economic results of the ventriculoperitoneal shunt infections in children

Kanık¹,

Sirin²,

Köse³

et al. 2014

Turkish Neurosurgery

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“…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.…”

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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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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“…Kan and Kestle described a study in children where converting from regular to AIS catheters diminished the shunt infection rate from 8.8% to 5.0% (10). In a similar, smaller study, Aryan et al found a reduction in infection rate in children from 15.2% to 3.1% (18). Richards et al published a retrospective review comparing AIS catheters against usual shunts (19).…”

Section: Discussionmentioning

confidence: 99%

The impact of antibiotic-impregnated catheters on ventriculoperitoneal shunt infection

Sorar¹,

Er²,

Özişik³

et al. 2014

Turk J Med Sci

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Previous studies on in vitro rooting for improved micropropagation of eucalypts indicated that root graviperception and postacclimatisation architecture are determined by the relative exogenous auxin analogue and its stability, supplied during the pre-rooting culture stages. The specific roles of indole-3-acetic acid (IAA) and indole-3-butyric acid (IBA) in the rooting medium on the in vitro root morphological processes were explored using a good-rooting clone. In vitro rooting percentage was significantly reduced when either of the auxin inhibitors 2,3,5-triiodobenzoic acid (TIBA) and ρ-chlorophenoxyisobutyric acid (PCIB) or the auxin antagonist kinetin was supplied at rooting, with or without exogenous auxin. For all treatments, at the time of root induction, shoots did not possess a vascular cambium, only procambial tissue, from where adventitious roots formed. However, when the inhibitors or the antagonist were supplied to the roots 3 days after root induction, they affected root growth and graviperception. Kinetin and PCIB significantly reduced the mean root diameter from 552.8 µm (control) to 129.2 µm and 278.6 µm, respectively, over 3 weeks. While the PCIB treatment resulted in a significant increase in Δ root length over this period, the TIBA treatment significantly decreased ∆ root length and increased mean root diameter to 833.4 µm. Restricting IAA transport with TIBA further altered root vascular patterning and, as with PCIB, resulted in the collapse of the columella region. Nevertheless, only a disruption in IAA transport and subsequent auxin distribution by TIBA treatment resulted in altered root graviperception. The results suggest the necessary inclusion of IAA in eucalypt micropropagation protocols to ensure good quality roots.

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Initial experience with antibiotic-impregnated silicone catheters for shunting of cerebrospinal fluid in children

Cited by 103 publications

References 38 publications

Clinic and economic results of the ventriculoperitoneal shunt infections in children

Clinic and economic results of the ventriculoperitoneal shunt infections in children

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

The impact of antibiotic-impregnated catheters on ventriculoperitoneal shunt infection

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