Antibiotic-impregnated catheters for the prevention of CSF shunt infections: a systematic review and meta-analysis

Thomas, Rebecca; Lee, Sharon; Patole, Sanjay; Rao, Shripada

doi:10.3109/02688697.2011.603856

Cited by 72 publications

(52 citation statements)

References 37 publications

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“…The findings of the current study are consistent with previous systematic reviews and meta-analyses of the literature, each of which found antibiotic-impregnated shunt catheters to be associated with a reduced incidence of CSF infection. 36,49 The systematic literature review by Parker et al demonstrated AICs to be associated with a significant infection reduction overall (3.3% vs 7.2%), in adultspecific cohorts (0.9% vs 5.8%), and in pediatric-specific cohorts (5.0% vs 11.2%). 36 Similarly, the meta-analysis performed by Thomas et al concluded that AICs may be an effective means of reducing the incidence of shunt and external ventricular drain infections.…”

Section: Discussionmentioning

confidence: 99%

“…36 Similarly, the meta-analysis performed by Thomas et al concluded that AICs may be an effective means of reducing the incidence of shunt and external ventricular drain infections. 49 Ventricular shunts provide a reliable means of treatment for hydrocephalus in both adult and pediatric patients; however, shunt infection remains a relatively common complication, occurring in 5%-10% of patients. 36,49 This represents a 3-to 5-fold increase in infection rate compared with other neurosurgical procedures.…”

Section: Discussionmentioning

confidence: 99%

“…49 Ventricular shunts provide a reliable means of treatment for hydrocephalus in both adult and pediatric patients; however, shunt infection remains a relatively common complication, occurring in 5%-10% of patients. 36,49 This represents a 3-to 5-fold increase in infection rate compared with other neurosurgical procedures. 24 Most often, infection results from colonization of the shunt system by normally nonpathogenic skin flora at the time of surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Recent meta-analyses have also demonstrated AICs to be associated with a significant reduction in incidence of CSF shunt infection for both adult and pediatric populations. 36,49 The varying conclusions of the small, single-institution studies in the literature to date underlines the importance of a large sample size study with multiple hospitals from diverse practice settings to adequately assess the potential benefit of AICs. Hence, we set out to determine the incidence of CSF shunt infection in both adult and pediatric patients undergoing ventricular shunt placement with antibiotic-impregnated versus standard shunt catheters as reported in a large nationwide administrative database.…”

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confidence: 99%

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Comparative effectiveness of antibiotic-impregnated shunt catheters in the treatment of adult and pediatric hydrocephalus: analysis of 12,589 consecutive cases from 287 US hospital systems

Parker

McGirt

Murphy³

et al. 2015

JNS

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OBJECT The real-world effectiveness of antibiotic-impregnated shunt catheters to reduce the incidence of shunt infections is still debated. The literature to date consists mostly of small, single-institution studies. The aim of this study was to assess the incidence of infection for antibiotic-impregnated catheters (AICs) versus standard shunt catheters in a large nationwide administrative database. METHODS The authors retrospectively reviewed hospital discharge and billing records from the Premier Perspective Database from April 2003 to July 2009 to identify all adult and pediatric patients undergoing de novo ventricular shunt placement. The primary end point was the incidence of shunt infection within 1 year of implantation. Multivariate logistical regression was performed to determine factors associated with increased incidence of infection. RESULTS A total of 10,819 adult (AIC, 963; standard catheter, 9856) and 1770 pediatric (AIC, 229; standard catheter, 1541) patients underwent ventricular shunt placement in 287 US hospitals. Overall, the incidence of infection was 3.5% in adults (n = 380) and 6.6% in pediatric patients (n = 116). AICs were associated with significant reduction in infection for both adult (2.2% vs 3.6%, p = 0.02) and pediatric (2.6% vs 7.1%, p < 0.01) patients. AIC use was associated with reduced infection regardless of hospital size, annual shunt volume, hospital location, or patient risk factors and remained associated with a reduced infection in multivariate analysis for both adult (p = 0.02) and pediatric (p = 0.02) patients. CONCLUSIONS The use of antibiotic-impregnated shunt catheters was associated with a reduction in shunt infections for both adult and pediatric patients. This provides further support that AICs may represent a reliable means of reducing shunt infections for both adult and pediatric patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Comparative effectiveness of antibiotic-impregnated shunt catheters in the treatment of adult and pediatric hydrocephalus: analysis of 12,589 consecutive cases from 287 US hospital systems

Parker

McGirt

Murphy³

et al. 2015

JNS

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“…The current literature suggests that antibiotic-coated [6,7]. It stands to reason that there would be a similar effect for VADs.…”

Section: Vad Infection Ratementioning

confidence: 99%

Ventricular access device infection rate: a retrospective study and review of the literature

et al. 2014

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Purpose Ventricular access devices (VAD) are often used for treatment of posthemorrhagic hydrocephalus (PHH) in preterm infants. The reported rates of infection have varied and range from 0 to 22 %. The objective of our study is to present our VAD associated infection at our institution. Methods The charts for patients that had VADs inserted between May 1, 2009 and October 31, 2013 at a single institution (Children's Healthcare of Atlanta) were retrospectively reviewed. The number of VAD infections, defined as either cerebrospinal fluid (CSF)-positive cultures or wound complication, was recorded. Of patients that survived, the number of VAD to shunt conversions was also examined. The data from 15 previously published studies were pooled to determine overall VAD infection and VAD to shunt conversion rates. Results A total of 142 VADs were placed. There were 13 infections (9.2 %), 11 of which had CSF-positive cultures (7.7 %). There were two wound complications with negative CSF cultures. Six patients died after VAD placement for reasons unrelated to their VAD surgeries (4.2 %). In the remaining patients, there were 113 VAD to shunt conversions (83.1 %). Fifteen studies that reported VAD infections were analyzed; an overall infection rate of 7.0 % and VAD to shunt conversion rate of 79 % were calculated. Conclusions While VAD is a valuable tool to treat PHH, it remains a procedure with an infection rate between 7.0 and 8.0 %. Close follow-up is needed to capture these adverse events as early as possible. Approximately 80 % of patients with PHH will require permanent CSF diversion.

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Antimicrobial-impregnated central venous catheters for prevention of catheter-related bloodstream infection in newborn infants

Balain

Oddie

McGuire

2015

Cochrane Database of Systematic Reviews

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Antibiotic-impregnated catheters for the prevention of CSF shunt infections: a systematic review and meta-analysis

Abstract: A meta-analysis of mainly observational studies suggests that AICs may be an effective way of reducing the incidence of shunt and EVD infections. Well-designed multi-centre RCTs are urgently needed.

Cited by 72 publications

References 37 publications

Comparative effectiveness of antibiotic-impregnated shunt catheters in the treatment of adult and pediatric hydrocephalus: analysis of 12,589 consecutive cases from 287 US hospital systems

Comparative effectiveness of antibiotic-impregnated shunt catheters in the treatment of adult and pediatric hydrocephalus: analysis of 12,589 consecutive cases from 287 US hospital systems

Ventricular access device infection rate: a retrospective study and review of the literature

Antimicrobial-impregnated central venous catheters for prevention of catheter-related bloodstream infection in newborn infants

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