Antimicrobial suture wound closure for cerebrospinal fluid shunt surgery: a prospective, double-blinded, randomized controlled trial

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Implantation of cerebrospinal fluid (CSF) shunting devices is associated with a 5–15% risk of infection as cited in contemporary pediatric neurosurgical literature. Shunt infections typically require complete removal of the device and prolonged antibiotic treatment followed by shunt replacement. Moreover, shunt infections are commonly associated with prolonged hospital stays, potential comorbidity, and the increased risk of neurological compromise due to ventriculitis or surgical complications. The authors prospectively evaluated the incidence of CSF shunt infection following shunt procedures performed using either antimicrobial suture (AMS) or conventional suture.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>In a single-center, prospective, double-blinded, randomized controlled trial, the authors enrolled 61 patients, among whom 84 CSF shunt procedures were performed over 21 months. Randomization to the study (AMS) or control (placebo) group was stratified to minimize the effect of known shunt infection risk factors on the findings. Antibacterial shunt components were not used. The primary outcome measure was the incidence of shunt infection within 6 months of surgery.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The shunt infection rate in the study group was 2 (4.3%) of 46 procedures and 8 (21%) of 38 procedures in the control group (p = 0.038). There were no statistically significant differences in shunt infection risk factors between the groups (procedure type and time, age &lt; 6 months, weight &lt; 4 kg, recent history of shunt infection). No suture-related adverse events were reported in either group.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>These results support the suggestion that the use of AMS for CSF shunt surgery wound closure is safe, effective, and may be associated with a reduced risk of postoperative shunt infection. A larger randomized controlled trial is needed to confirm this association.</jats:p></jats:sec>

Efficacy of antimicrobial sutures in reducing surgical site infection during hernia surgery: a comparative study

“…Further, triclosan have been reported in the inhibition of SSI in gynaecological, neuro, thoracic, and abdominal surgery. 14,15 However, the usage of TC-coated sutures displayed negative results in various clinical studies. In one clinical study, TC-coated sutures used for wound closure after appendectomy or head and neck surgery, failed to reduce the infection rate post operatively.…”

Transverse Sinus Stenting for Pseudotumor Cerebri: A Cost Comparison with CSF Shunting

“…22,23 Given the variation in shunt infection rates and potentially reduced rates resulting from the more widespread use of antibiotic-impregnated shunt components, our scenario analyses included reduced infection rates of 10% and 5%, to investigate the impact on total cost. The scenarios demonstrate that reduced rates of infection, while reducing the magnitude of the cost difference, nonetheless confirm the substantially lower cost of venous stenting in all cases.…”

Complications Associated with Surgical Treatment of Hydrocephalus

“…There have been investigations of the effect of more simple techniques, focusing on intraoperative sterile conditions such as intraoperative irrigation (Hayashi et al, 2008(Hayashi et al, , 2010, changing gloves before handling the shunt catheter (Sørensen et al, 2008, Rehman et al, 2010 or a double-gloving strategy (Tulipan & Cleves, 2006), and antimicrobial suture wound closure (Rozzelle et al, 2008). Where AIS is unavailable, we recommend the systemic administration of antibiotics, generous intraoperative irrigation and double-gloving.…”