Antibiotic prophylaxis for surgical introduction of intracranial ventricular shunts: a systematic review

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Systemic antibiotics and antibiotic-impregnated shunt (AIS) systems are often used to prevent shunt infection. The authors conducted a systematic review to evaluate its effectiveness of antibiotics in patients who underwent placement of intracranial ventricular shunts.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The authors searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, LILACS, and the meeting proceedings from the American Association of Neurological Surgeons and from the European Association of Neurosurgical Societies until June 2005. Randomized and quasi-randomized trials comparing the use of prophylactic antibiotics (either systemic or AIS systems) in intracranial ventricular shunt procedures with placebo or no antibiotics were included in the review.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Seventeen trials involving 2134 patients were included. Results from the metaanalysis showed that the use of systemic antibiotic prophylaxis for internal shunts was associated with a decrease in shunt infection (odds ratio 0.51; 95% confidence interval 0.36–0.73). The authors found no significant differences between the subgroups evaluated in type of internal shunt (ventriculoperitoneal/ventriculoatrial), age, or duration of the administration of antibiotics.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The authors found a benefit of systemic prophylactic antibiotics in preventing shunt infection, regardless of the patient's age and the type of internal shunt used. The benefit of its use after the first 24 hours postoperatively remains uncertain. Future trials should be conducted to evaluate the effectiveness of different regimens of systemic antibiotics rather than placebo, namely single preoperative dose versus multiple doses. It should also be mandatory to evaluate the effectiveness of systemic prophylactic antibiotics for external ventricular drains. Evidence suggests that antibiotic-impregnated catheters reduce the incidence of shunt infection, although more well-designed clinical trials are needed.</jats:p></jats:sec>

Prospective surveillance of complications in a pediatric neurosurgery unit

“…There is good evidence that prophylactic antibiotics can reduce this rate, which unfortunately remains > 5% in most pediatric centers with its use. 18 Shunt infection is also related to age, with younger children manifesting higher infection rates. 6 Cerebrospinal fluid leakage, discussed above, is also a significant risk factor for shunt infection; therefore, meticulous attention to detail and especially to wound closure 13 is paramount.…”

Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 6: Preoperative antibiotics for shunt surgery in children with hydrocephalus: a systematic review and meta-analysis

“…28 The administration of preoperative antibiotic agents, typically those providing gram-positive coverage such as a first-generation cephalosporin, nafcillin, clindamycin, or vancomycin, has been demonstrated or is assumed to lower the infection rate for all major cranial and spinal neurosurgical procedures. [4][5][6] Numerous studies, including 3 meta-analyses, 21,24,29 have investigated the use of preoperative antibiotics as prophylaxis against shunt infection, both for adult and pediatric patients. Many of the original trials date back to the 1980s, and it is one of the few areas in neurosurgery in which there is an abundance of randomized controlled trials (RCTs).…”

Characteristics and management of ventricular shunt infections in children, 2000-2015: a single centre retrospective chart review

“…One of the most important actions shown to reduce shunt infections is perioperative prophylactic antibiotics, with the literature supporting their use in all patients undergoing a shunt insertion 2,24 . A systematic review and meta-analysis by Ratilal et al demonstrated that antibiotic prophylaxis can significantly decrease the rate of shunt infection (OR 0.51, 95% CI 0.36-0.73) 25 . Only 65% of the patients in our populations Antibiotics used per infection (n) 3 3-5 1 9…”