The impact of antibiotic-impregnated catheters on ventriculoperitoneal shunt infection
Ventriculoperitoneal shunt infections remain an important problem and result mainly from perioperative colonization of shunt components by skin flora. Antibiotic-impregnated shunts have been designed to prevent such colonization. This study evaluates the incidence of shunt infection after the insertion of antibiotic-impregnated shunts in a population of children with hydrocephalus. Materials and methods: All pediatric patients who had undergone cerebrospinal fluid shunt insertion retrospectively were reviewed over a 6-year period between May 2004 and December 2010. The primary outcome measure was the rate of shunt infections. Patients were followed up with for an average of 26.2 months after shunt surgery, and shunt infections were evaluated. Results: A total of 123 pediatric patients underwent 211 shunt placement procedures. Of these operations, 193 (91%) were performed with nonimpregnated catheters and 18 shunts (9%) were placed with antibiotic-impregnated shunt catheters. Of the patients with nonimpregnated catheters, 12 (6%) experienced shunt infection, whereas none of the patients with antibiotic-impregnated catheters experienced shunt infection within the 26.2-month follow-up period (P < 0.01). Conclusion: The antibiotic-impregnated catheters significantly reduced the incidence of shunt infection in children with hydrocephalus during the postoperative period. Antibiotic-impregnated catheters are effective devices to prevent perioperative colonization of shunt components.
The impact of antibiotic-impregnated catheters on ventriculoperitoneal shunt infection
Ventriculoperitoneal shunt infections remain an important problem and result mainly from perioperative colonization of shunt components by skin flora. Antibiotic-impregnated shunts have been designed to prevent such colonization. This study evaluates the incidence of shunt infection after the insertion of antibiotic-impregnated shunts in a population of children with hydrocephalus. Materials and methods: All pediatric patients who had undergone cerebrospinal fluid shunt insertion retrospectively were reviewed over a 6-year period between May 2004 and December 2010. The primary outcome measure was the rate of shunt infections. Patients were followed up with for an average of 26.2 months after shunt surgery, and shunt infections were evaluated. Results: A total of 123 pediatric patients underwent 211 shunt placement procedures. Of these operations, 193 (91%) were performed with nonimpregnated catheters and 18 shunts (9%) were placed with antibiotic-impregnated shunt catheters. Of the patients with nonimpregnated catheters, 12 (6%) experienced shunt infection, whereas none of the patients with antibiotic-impregnated catheters experienced shunt infection within the 26.2-month follow-up period (P < 0.01). Conclusion: The antibiotic-impregnated catheters significantly reduced the incidence of shunt infection in children with hydrocephalus during the postoperative period. Antibiotic-impregnated catheters are effective devices to prevent perioperative colonization of shunt components.
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- Kan P, Kestle J. Lack of efficacy of antibiotic-impregnated shunt systems in preventing shunt infections in children. Childs Nerv Syst 2007; 23: 773–777.
- Sciubba DM, McGirt MJ, Woodworth GF, Carson B, Jallo GI. Prolonged exposure to antibiotic-impregnated shunt catheters does not increase incidence of late shunt infections. Childs Nerv Syst 2007; 23: 867–871.
- Thompson DN, Hartley JC, Hayward RD. Shunt infection: is there a near-miss scenario? J Neurosurg 2007; 106 (Suppl. 1): 15–19.
- McGirt MJ, Edwards N, Engelhart L. 121 Cost-consequences analysis of antibiotic-impregnated shunts and external ventricular drains (EVD) in hydrocephalus. Neurosurgery 2013; 60 (Suppl. 1): 160.
- Sciubba DM, Stuart RM, McGirt MJ, Woodworth GF, Samdani A, Carson B, Jallo GI. Effect of antibiotic-impregnated shunt catheters in decreasing the incidence of shunt infection in the treatment of hydrocephalus. J Neurosurg 2005; 103: 131–136.
- Sciubba DM, Lin LM, Woodworth GF, McGirt MJ, Carson B, Jallo GI. Factors contributing to the medical costs of cerebrospinal fluid shunt infection treatment in pediatric patients with standard shunt components compared with those in patients with antibiotic impregnated components. Neurosurg Focus 2007; 22: E9.
- Pattavilakom A, Xenos C, Bradfield O, Danks RA. Reduction in shunt infection using antibiotic impregnated CSF shunt catheters: an Australian prospective study. J Clin Neurosci 2007; 14: 526–531.
- Eymann R, Chehab S, Strowitzki M, Steudel WI, Keifer M. Clinical and economic consequences of antibiotic-impregnated cerebrospinal fluid shunt catheters. J Neurosurg Pediatrics 2008; 1: 444–450.
- Aryan HE, Meltzer HS, Park MS, Bennett RL, Jandial R, Levy ML. Initial experience with antibiotic-impregnated silicone catheters for shunting of cerebrospinal fluid in children. Childs Nerv Syst 2005; 21: 56–61.
- Richards HK, Seeley HM, Pickard JD. Efficacy of antibiotic- impregnated shunt catheters in reducing shunt infection: data from the United Kingdom Shunt Registry. J Neurosurg Pediatr 2009; 4: 389–393.