Late Shunt Infections

Baird, Clinton J.; O’Connor, Dennis M.; Pittman, Thomas

doi:10.1159/000028874

Cited by 54 publications

(43 citation statements)

References 12 publications

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“…Shunt infections with P. acnes are reported to occur in 0%-2% of all shunting procedures and comprise 0%-15% of such infections. 1,2 Schiff and Oakes 6 reviewed 1500 shunting procedures performed over a 9-year span and identified 12 patients with an infection more than 6 months later. Seven of the infections were identified following another surgical procedure or infection not related to the brain or spine.…”

Section: Discussionmentioning

confidence: 99%

What is the risk of infecting a cerebrospinal fluid–diverting shunt with percutaneous tapping?

Spiegelman

Asija

Silva

et al. 2014

PED

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Object Most CSF-diverting shunt systems have an access port that can be percutaneously tapped. Tapping the shunt can yield valuable information as to its function and whether an infection is present. The fear of causing a shunt infection by tapping may limit the physician's willingness to do so. The authors of this study investigate the risk of infecting a shunt secondary to percutaneous tapping. Methods Following institutional review board approval, CSF specimens obtained from tapping an indwelling CSF-diverting shunt during the 2011 and 2012 calendar years were identified and matched with clinical information. A culture-positive CSF sample was defined as an infection. If results were equivocal, such as a broth-only–positive culture, a repeat CSF specimen was examined. The CSF was obtained by tapping the shunt access port with a 25-gauge butterfly needle after prepping the unshaven skin with chlorhexidine. Results During the study period, 266 children underwent 542 shunt taps. With 541 taps, no clinical evidence of a subsequent shunt infection was found. One child's CSF went from sterile to infected 11 days later; however, this patient had redness along the shunt tract at the time of the initial sterile tap. Conclusions The risk of infection from tapping a shunt is remote if the procedure is done correctly.

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Section: Discussionmentioning

confidence: 99%

What is the risk of infecting a cerebrospinal fluid–diverting shunt with percutaneous tapping?

Spiegelman

Asija

Silva

et al. 2014

PED

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“…The risk of shunt infection is 8-10% during the first months in large trials (Enger et al 2003). It is highest during the first two months after surgery and 90% of these infections occur during the first six months (Baird et al 1999). Infectious complications are responsible for increased morbidity and mortality and lengthy hospitalisation periods.…”

Section: Complicationsmentioning

confidence: 99%

Vision in children with hydrocephalus

Andersson¹,

Persson²,

Aring³

et al. 2006

Dev Med Child Neurol

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Aims: To analyse trends in the live-birth prevalence of infantile hydrocephalus and hydrocephalus associated with myelomeningocele (MMC) during the period [1989][1990][1991][1992][1993][1994][1995][1996][1997][1998][1999][2000][2001][2002] and to study the outcome in terms of learning disability, cerebral palsy, epilepsy and visual deficits. Another objective was to explore motor function and disability profiles in various aetiological and gestational-age subgroups and to see whether treatment complications and neuroradiological findings correlate with outcome. Material and methods: A population-based study of all 262 live-born children with infantile hydrocephalus and hydrocephalus associated with MMC born in 1989-2002 in western Sweden. Aetiological and clinical information was collected from medical records, neuroimaging and ophthalmological examinations. A subgroup of 114 children were clinically examined and interviewed. Results: The live-birth prevalence of hydrocephalus was 0.77 per 1,000 live births, 0.48 for infantile hydrocephalus and 0.29 for hydrocephalus associated with MMC. The prevalence of infantile hydrocephalus decreased from 0.55 in 1989 to 0.48 per 1,000 in 2002, while that of MMC decreased from 0.35 to 0.16 per 1,000 during the same period. The prevalence in children born extremely preterm increased dramatically, with a gestational-age-specific prevalence of 13 per 1,000 in 1989 compared with 45 per 1,000 live births in 2002. During the same period, the perinatal mortality in these children decreased from 40 to 15 per 1,000 live births. A ventriculoperitoneal shunt was the first surgical intervention in 230 children (88%), while an endoscopic ventriculostomy was performed in 31 (12%). At least one surgical revision was required in 64% of the children. Of children with infantile hydrocephalus, 63% had at least one associated impairment, compared with 33% in the MMC group, apart from the consequences of the spinal lesion. Visual and other ophthalmological impairments were identified in the majority of the children. Very preterm birth was associated with a high risk of visual impairment. No child with normal neuroimaging had any associated neurological or visual impairment, compared with eleven of twelve with impairments in children with generalised parenchymal lesions. Conclusions: A decrease in the prevalence of infantile hydrocephalus was noted during the period 1989-1998, but it did not continue in 1999-2002. The stagnation was mainly explained by the increased survival of children born extremely preterm with post-haemorrhagic hydrocephalus. The aetiology of the hydrocephalus and gestational age at birth were important for outcome. The majority of the children had some associated neuroimpairment, such as learning disability, cerebral palsy or epilepsy, and more than three-quarters had ophthalmological abnormalities. Neuroimaging was found to be useful for aetiological, treatment and outcome considerations.

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Section: Neurosurg Focus 41 (5):e7 2016mentioning

confidence: 99%

“…However, we note that the majority of such literature tends to focus on early complicationsusually where the VPS fails within 1 or 2 years postoperatively. 3,4,16,32,42 Important examples are various VPS-related infections, which are commonly caused by skin bacteria inoculation into the wound or implant.3,4,43 Less frequent complications include VPS extrusion into visceral organs, and unusual VPS catheter disconnections. 11,21,24,26,30 OverAbbreviAtioNs ETV = endoscopic third ventriculostomy; VPS = ventriculoperitoneal shunt.…”

mentioning

confidence: 99%

Late pediatric ventriculoperitoneal shunt failures: a Singapore tertiary institution's experience

Lee

Low

et al. 2016

FOC

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OBJECTIVE The introduction of ventriculoperitoneal shunts changed the way hydrocephalus was treated. Whereas much is known about the causes of shunt failure in the first few years, there is a paucity of data in the literature regarding the cause of late shunt failures. The authors conducted a study to find out the different causes of late shunt failures in their institution. METHODS A 10-year retrospective study of all the patients who were treated in the authors' hospital between 2006 and 2015 was conducted. Late shunt failures included those in patients who had to undergo shunt revision more than 5 years after their initial shunt insertion. The patient's notes and scans were reviewed to obtain the age and sex of the patient, the time it took for the shunt to fail, the reason for failure, and the patient's follow-up. RESULTS Forty-six patients in the authors' institution experienced 48 late shunt failures in the last 10 years. Their ages ranged from 7 to 26 years (12.23 ± 4.459 years [mean ± SD]). The time it took for the shunts to fail was between 6 and 24 years (mean 10.25 ± 3.77 years). Reasons for failure resulting in shunt revision include shunt fracture in 24 patients (50%), shunt blockage in 14 patients (29.2%), tract fibrosis in 6 patients (12.5%), shunt dislodgement in 2 patients (4.2%), and shunt erosion in 2 patients (4.2%). Postoperative follow-up for the patients ranged from 6 to 138 months (mean 45.15 ± 33.26 months). CONCLUSIONS Late shunt failure is caused by the effects of aging on the shunt, and the complications are different from early shunt failure. A large proportion are complications associated with shunt calcification. The authors advocate a long follow-up for pediatric patients with shunts in situ to monitor them for various causes of late shunt failure.

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Late Shunt Infections

Cited by 54 publications

References 12 publications

What is the risk of infecting a cerebrospinal fluid–diverting shunt with percutaneous tapping?

What is the risk of infecting a cerebrospinal fluid–diverting shunt with percutaneous tapping?

Vision in children with hydrocephalus

Late pediatric ventriculoperitoneal shunt failures: a Singapore tertiary institution's experience

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