Risk factors for pediatric surgical site infection following neurosurgical procedures for hydrocephalus: a retrospective single-center cohort study

Abstract

Background Infection is a major complication following cerebral spinal fluid (CSF) diversion procedures for hydrocephalus. However, pediatric risk factors for surgical site infection (SSI) are currently not well defined. Because a SSI prevention bundle is increasingly introduced, the purpose of this study was to evaluate risk factors associated with SSIs following CSF diversion surgeries following a SSI bundle at a single quaternary care pediatric hospital. Methods We performed a retrospective cohort study of patients undergoing CSF diversion procedures from 2017 to 2019. SSIs were identified prospectively through continuous surveillance. We performed unadjusted logistic regression analyses and univariate analyses to determine an association between SSIs and patient demographics, comorbidities and perioperative factors to identify independent risk factors for SSI. Results We identified a total of 558 CSF diversion procedures with an overall SSI rate of 3.4%. The SSI rates for shunt, external ventricular drain (EVD) placement, and endoscopic third ventriculostomy (ETV) were 4.3, 6.9 and 0%, respectively. Among 323 shunt operations, receipt of clindamycin as perioperative prophylaxis and presence of cardiac disease were significantly associated with SSI (O.R. 4.99, 95% C.I. 1.27–19.70, p = 0.02 for the former, and O.R. 7.19, 95% C.I. 1.35–38.35, p = 0.02 for the latter). No risk factors for SSI were identified among 72 EVD procedures. Conclusion We identified receipt of clindamycin as perioperative prophylaxis and the presence of cardiac disease as risk factors for SSI in shunt procedures. Cefazolin is recommended as a standard antibiotic for perioperative prophylaxis. Knowing that unsubstantiated beta-lactam allergy label is a significant medical problem, efforts should be made to clarify beta-lactam allergy status to maximize the number of patients who can receive cefazolin for prophylaxis before shunt placement. Further research is needed to elucidate the mechanism by which cardiac disease may increase SSI risk after shunt procedures.

Antibacterial Designs for Implantable Medical Devices: Evolutions and Challenges

“…Infection is a common and frequent complication associated with all types of biomedical materials, despite the infection rate varying greatly among different intended uses of various implantable devices ( Table 2 ) [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 ]. Orthopedic implants, such as the ankle, hip, knee, elbow, shoulder, and finger joint prosthetics, are made of metals (titanium alloys, stainless steel, cobalt-chromium alloy, etc.)…”

Antibacterial and biocompatibility studies of triple antibiotics-impregnated external ventricular drainage: In vitro and in vivo evaluation

“…This disturbing event can notably cause some diseases such as hematoma, tumor, abscess, and hydrocephalus [ 1 , 2 ]. Hydrocephalus is a neurological condition occurred by an unusually high level of cerebrospinal fluid (CSF), which results in its abnormal accumulation within the ventricles [ 3 , 4 ]. The disease can occur at any age, and if it is left untreated, it may result in severe neurological injury and death [ 5 ].…”

“…The disease can occur at any age, and if it is left untreated, it may result in severe neurological injury and death [ 5 ]. Hydrocephalus can be treated long-term by insertion of a ventriculoperitoneal shunt (VP shunt) and short-term by external ventricular drainage (EVD) [ 3 ].…”

“…There are some complications from EVD usage, including hemorrhage, dislodgement, and, especially, infection [ 6 ]. Neurological infection after surgery, so-called surgical site infections (SSIs), can lead to severe problems such as malfunction of the device, seizures and neurological deficits [ 3 ]. The infection rate associated with EVD is approximately 10% and significantly suggests a more extended stay at the hospital and resource consumption [ 2 , 6 ].…”

Cerebrospinal fluid shunt–associated surgical site infection with three-month versus twelve-month surveillance periods in Canadian hospitals

“…(Received 6 February 2022; accepted 13 April 2022; electronically published 16 June 2022) Cerebrospinal fluid (CSF) shunt surgeries provide lifesaving treatment for hydrocephalus, but they are frequently associated with revision surgeries, infections, and substantial clinical and financial consequences. 1 Postoperative shunt infections are the most costly implant-related infection to treat in the United States, 2 requiring hospital readmission with potential surgery and critical care. 3 Despite advances in perioperative care and shunt technology, rates of complication and revision surgery remain relatively high, 4 highlighting the need for efforts to prevent infections.…”