Pre-Operative CSF Analysis as a Prognostic Factor for Shunt Infection in Children

Abstract

Background: Ventriculoperitoneal (VP) shunting is a common surgical intervention for pediatric hydrocephalus, yet it is frequently complicated by shunt infections, leading to significant morbidity and mortality. The role of intraoperative cerebrospinal fluid (CSF) sampling in predicting these infections remains unclear, with limited evidence available, particularly in the pediatric population. Objective: To evaluate the efficacy of intraoperative CSF sampling as a prognostic tool for shunt infections in pediatric patients undergoing VP shunt procedures. Methods: This prospective study was conducted at Jinnah Post Graduate Medical Centre and included 100 pediatric patients (60% female, 40% male) who underwent VP shunt placement from June to December 2022. Patients with previous cranial surgeries were excluded. Intraoperative CSF samples were analyzed for microbial presence. We assessed patient demographics, clinical conditions necessitating VP shunt, shunt type, and follow-up data, including shunt infection or malfunction incidents. The main outcome measured was the correlation between intraoperative CSF sampling results and subsequent shunt infections, defined as positive culture from CSF or hardware. Results: During the 6-month follow-up, 20% of the patients required shunt revision, with 5% (5 patients) developing shunt infections. All intraoperative CSF samples were sterile. Infections were predominantly caused by coagulase-negative staphylococcus and occurred despite negative intraoperative CSF results. The infection rate among those who underwent revision was 25%. Conclusion: The study indicates a lack of correlation between sterile intraoperative CSF samples and the subsequent development of shunt infections in pediatric patients. This finding challenges the necessity of routine intraoperative CSF sampling during VP shunt insertion in the pediatric population.