Risk of infection after cerebrospinal fluid shunt: An analysis of 884 first-time shunts

Abstract

Postoperative infections are major complications of cerebrospinal fluid (CSF) shunting in the treatment of hydrocephalus and other conditions with obstructed CSF circulation. In a retrospective study 884 first-time shunted patients with hydrocephalus operated on in the years 1958-1989 were investigated with special reference to the infection rate and to the influence of the following variables: time period, age of the patient, education of the neurosurgeon, length and time of the operation and the exact placement of the distal drain. The overall infection rate for all implanted CSF shunts was 7.4% (5.7-9.3%) and the acute rate of infection was 6.2% (4.6-7.9%). The rate of infection was virtually constant for all variables with the exception of the education of the neurosurgeon. Neurosurgical trainees particularly had a significantly higher rate of infection. Shunt infection is still a major complication. The infection rate has not declined in recent decades. It is not possible to relate any main cause to the infection rate. The literature recommends removal of the infected shunt combined with antibiotics. The use of prophylactic antibiotics is still controversial. No prospective, double-blind studies, including a sufficiently large number of patients to evaluate this issue, exist today.

Infections of external ventricular drainages

“…This result is in concordance with the findings of other studies, which disputed their effect on higher infection rate [12][13][14].…”

Clinic and economic results of the ventriculoperitoneal shunt infections in children

“…The exclusion criteria were VPSI before the study period, a history of a shunt operation in another center, and a lack of medical records. The criteria for a diagnosis of CSF shunt infection were as follows: a positive CSF culture, CSF findings consistent with infection (leukocyte count of >50/mm 3 or glucose ratio [CSF glucose/serum glucose] of <0.4) associated with fever [temperature of >38.5°C]), shunt malfunction, or neurological symptoms (17,20,27). Burr-hole type shunts were placed in all patients with medium pressure adjustment (70-110 mmH 2 O), and cefazolin sodium prophylaxis was intravenously administered before the skin incision (25 mg/kg); two doses were repeated within 24h after the surgery (12,21).…”

“…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).…”

Infecções em dispositivos neurológicos implantáveis em crianças e adolescentes

“…O tempo cirúrgico não foi considerado significante estatisticamente como fator de risco para infecção de sistema de DVP por outros autores 8,18 . A duração dos procedimentos observada em nosso estudo teve uma média de 83,7±34,2 minutos, denotando um tempo cirúrgico prolongado.…”