Long-term analysis of cerebrospinal fluid shunt infections

George, Randolph; Leibrock, Lyal G.; Epstein, Miran

doi:10.3171/jns.1979.51.6.0804

Cited by 282 publications

(137 citation statements)

References 26 publications

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“…Although rapid detection of S. aureus in clinical specimens is essential for appropriate patient care, the recovery and identification of other staphylococci is also important, especially from catheters and other foreign-body samples and blood cultures (16)(17)(18)(19)(20)(21). Culture-based detection methods are cost-effective and useful, especially when various microbe species are examined.…”

Section: Discussionmentioning

confidence: 99%

Performance of Sa Select , a Chromogenic Medium for Detection of Staphylococci in Clinical Specimens

Hirvonen¹,

Kerttula²,

Kaukoranta³

2014

J Clin Microbiol

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bIn a preliminary study, known staphylococcus (n ‫؍‬ 86) and other microbial (n ‫؍‬ 12) isolates were plated on three chromogenic media, SaSelect (Bio-Rad, Hercules, CA, USA), CHROMagar Staph. aureus (CHROMagar Microbiology, Paris, France), and S. aureus ID (bioMérieux, Marcy l'Etoile, France). The sensitivities of all the media to detect Staphylococcus aureus after 24 h of incubation were high (100.0%). However, their specificities varied at 93.3% (95% confidence interval [CI], 86.0% to 100.0%) (CHROMagar Staph. aureus), 97.8% (95% CI, 93.5% to 100.0%) (S. aureus ID), and 100.0% (SaSelect). SaSelect also showed the highest sensitivity for recovery and differentiation of other staphylococci. As the best performing chromogenic medium, SaSelect was then prospectively compared to conventional culture and identification tests for the detection of staphylococci from 2,780 clinical specimens. A total of 1,589 staphylococcal isolates were recovered. Of these, 912 were S. aureus and 677 were other staphylococci. The sensitivity and specificity of SaSelect to detect S. aureus in clinical specimens after 24 h of incubation were 99.6% and 99.9% (95% CI, 99.2% to 100.0% and 99.8% to 100.0%), respectively, whereas the sensitivity and specificity using conventional plates combined with laboratory identification methods were 96.8% and 99.5% (95% CI, 95.7 to 97.9% and 99.2% to 99.8%). For the recovery and preliminary identification of other staphylococci, the sensitivity and specificity of SaSelect were 94.4% and 99.9%. SaSelect is a well-performing chromogenic medium that significantly improved the detection of staphylococci, especially S. aureus, compared to conventional culture (P < 0.0001).

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Section: Discussionmentioning

confidence: 99%

Performance of Sa Select , a Chromogenic Medium for Detection of Staphylococci in Clinical Specimens

Hirvonen¹,

Kerttula²,

Kaukoranta³

2014

J Clin Microbiol

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“…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 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). The risk of infection is affected by factors including patient age, immunologic status, factors associated with the surgery and surgeon, materials used, surgical technique, and the number of previous shunt surgeries (5).…”

Section: Introductionmentioning

confidence: 99%

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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“…One hundred sixty-two articles were excluded based on a review of the abstract. Twenty-two full-length papers were reviewed, of which 13 were rejected for the following reasons: studies either enrolled only adults or J Neurosurg: Pediatrics / Volume 14 / November 2014 separate results for children were not provided; 8,10,19,31,41 there was no comparison group; 2 prophylactic antibiotic use was part of a shunt surgery protocol, and thus more than one variable was conceivably being altered; 23,38 clinical shunt infection was not used as the outcome; 7 no details regarding the prophylaxis used were provided; 32 a variety of antibiotics was used (that is, there was no standardization of the prophylaxis protocol); 44 or data specific to shunt surgery were not available. 12,43 Therefore, 9 articles satisfied inclusion criteria for this systematic review and meta-analysis (Table 1).…”

Section: Search Resultsmentioning

confidence: 99%

Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 6: Preoperative antibiotics for shunt surgery in children with hydrocephalus: a systematic review and meta-analysis

Klimo

Poppel

Thompson

et al. 2014

PED

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Object The objective of this systematic review and meta-analysis was twofold: to answer the question “What is the evidence for the effectiveness of prophylactic intravenous antibiotics for infection prevention in shunt surgery?” and to make treatment recommendations based on the available evidence. Methods The US National Library of Medicine PubMed/MEDLINE database and the Cochrane Database of Systematic Reviews were queried using MeSH headings and key words relevant to prophylactic antibiotic use in children undergoing a shunt operation. Abstracts were reviewed to identify which studies met the inclusion criteria. An evidentiary table was assembled summarizing the studies and the quality of evidence (Classes I-III). A meta-analysis was conducted using a random-effects model to calculate a cumulative estimate of treatment effect using risk ratio (RR). Heterogeneity was assessed using chi-square and I2 statistics. A sensitivity analysis was also conducted. Based on the quality of the literature and the result of the meta-analysis, a recommendation was rendered (Level I, II, or III). Results Nine studies (4 Class I, 3 Class II, and 2 Class III) met our inclusion criteria. Of 7 randomized controlled trials (RCTs), 3 were downgraded from Class I to Class II because of significant quality issues, and all RCTs were potentially underpowered. In only 2 Class in retrospective cohort studies were preoperative antibiotic agents found to be protective against shunt infection. When data from the individual studies were pooled together, the infection rate in the prophylactic antibiotics group was 5.9% compared with 10.7% in the control group. Using a random-effects model, the cumulative RR was 0.55 (95% CI 0.38–0.81), indicating a protective benefit of prophylactic preoperative intravenous antibiotics. A sensitivity analysis of RCTs only (n = 7) also demonstrated a statistical benefit, but an analysis of higher-quality RCTs only (n = 4) did not. Conclusions Within the limits of this systematic review and meta-analysis, administration of preoperative antibiotic agents for shunt surgery in children was found to lower the infection risk (quality of evidence: Class II; strength of recommendation, Level II). Recommendation The use of preoperative antibiotic agents can be recommended to prevent shunt infection in patients with hydrocephalus. It was only by combining the results of the various underpowered studies (meta-analysis) that the use of preoperative antibiotics for shunt surgery in children was shown to lower the risk of shunt infection. Strength of Recommendation: Level II, moderate degree of clinical certainty.

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Long-term analysis of cerebrospinal fluid shunt infections

Cited by 282 publications

References 26 publications

Performance of Sa Select , a Chromogenic Medium for Detection of Staphylococci in Clinical Specimens

Performance of Sa Select , a Chromogenic Medium for Detection of Staphylococci in Clinical Specimens

Clinic and economic results of the ventriculoperitoneal shunt infections in children

Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 6: Preoperative antibiotics for shunt surgery in children with hydrocephalus: a systematic review and meta-analysis

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