Antibiotic-Impregnated Shunt Catheters for the Treatment of Infantile Hydrocephalus

Abstract

Introduction: Antibiotic-impregnated shunt (AIS) components decrease shunt infections by preventing bacterial colonization that occurs during implantation. Despite studies showing improved efficacy in preventing infection however, concern still exists regarding using AIS components in infants, especially premature ones. In this study, clinical outcomes were assessed in infants with hydrocephalus (<1 year) following AIS placement. Methods: A prospective observational study was conducted involving pediatric patients <1 year of gestational age with hydrocephalus who underwent placement of AIS components (ventriculoperitoneal, ventriculoatrial, and cystoperitoneal) as initial treatments, shunt revision surgery, or following previous placement of a ventricular access device (VAD, Rickman reservoir). Measured outcomes included: infection, shunt revision surgery, and complications. Results: Seventy-four infants underwent 108 AIS procedures, and all were followed for over 9 months. Twenty-seven patients (36.5%) possessed previous VADs. Average weight and gestational age at birth were 1,976 g (range: 560–3,500 g) and 32.8 weeks (range: 23–41 weeks), respectively. The average age at the time of surgery was 14.6 weeks (range: 1 day to 50 weeks). Five infections occurred in 5 patients (4.6% of procedures, 6.75% of patients), 60% of which were very premature (<32 weeks). Thirty-three patients (44.6%) required shunt revision surgery, 5 (15%) for infection and 28 (85%) for malfunction. Three cerebrospinal fluid leaks occurred perioperatively without significant sequelae, and no mortalities occurred from the procedures. Conclusion: AIS systems can safely be used to treat hydrocephalus in pediatric patients <1 year old, even for those with a history of prematurity. One possible therapeutic application for such premature patients may be the incorporation of antibiotic impregnation into VADs or ventriculosubgaleal components to treat infants with hydrocephalus prior to definitive CSF shunt placement.

Ventricular reservoir versus ventriculosubgaleal shunt for posthemorrhagic hydrocephalus in preterm infants: infection risks and ventriculoperitoneal shunt rate

“…3,4,22 Within our cohort, there was no significant difference in the rates of VP shunting between temporizing device groups, with 77% of reservoir patients and 76% of VSGS patients eventually receiving VP shunts. In addition, the Cox proportional hazards model found a comparable cumulative incidence of VP shunt placement between the reservoir and VSGS groups.…”

Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 7: Antibiotic-impregnated shunt systems versus conventional shunts in children: a systematic review and meta-analysis

“…Nineteen full-length papers were reviewed, 13 of which were rejected for the following reasons: studies enrolled either adults only or enrolled mixed populations, but separate results for children were not provided, 1,19,20,36,38,44,45,51 or studies contained patient data that had also been reported in separate publications. 3,16,[47][48][49] In fact, 1 group of researchers published no less than 9 papers on AISs that included patients from overlapping time periods. 3,17,18,35,36,[47][48][49][50] Therefore, 6 articles satisfied inclusion for this systematic review and meta-analysis (Table 1).…”

“…3,16,[47][48][49] In fact, 1 group of researchers published no less than 9 papers on AISs that included patients from overlapping time periods. 3,17,18,35,36,[47][48][49][50] Therefore, 6 articles satisfied inclusion for this systematic review and meta-analysis (Table 1). 2,15,24,27,28,50 …”

Shunt revision requirements after posthemorrhagic hydrocephalus of prematurity: insight into the time course of shunt dependency

“…The use of temporizing devices has variable success in reducing shunt placement, as in most studies of reservoirs and VSGSs, the majority of patients go on to permanent shunt insertion [10,29,31,32]. Antibioticimpregnated shunts may be capable of reducing the rates of shunt infection in pediatric hydrocephalus, but do not address the most common cause of shunt failure, proximal obstruction [13,18]. A wide variety of shunt systems are currently available to clinicians, but their impact on shunt failures rates is unclear.…”