Cerebrospinal fluid shunt infections in infants and children in Mobile, Alabama

Mancao, M.; Miller, Chad M.; Cochrane, Barbara; Hoff, Charles; Sauter, Kendall E.; Weber, E.

doi:10.1111/j.1651-2227.1998.tb01527.x

Cited by 39 publications

(10 citation statements)

References 9 publications

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“…When examining the studies presented in evidence in Table 3 2,10,20,34 and Table 4, 8,9,[13][14][15]21,24,26,30,31 it is difficult to say with any degree of clinical certainty whether complete shunt removal leads to better shunt infection treatment outcomes than partial shunt removal. This is due, in part, to the paucity of outcome data comparing the 2 treatment options within the same study population, but also to the confounding effect of intrathecal antibiotic therapy, as described above.…”

Section: Arnell Et Al 2007mentioning

confidence: 99%

Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 8: Management of cerebrospinal fluid shunt infection

Tamber

Klimo

Mazzola

et al. 2014

PED

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Object The objective of this systematic review was to answer the following question: What is the optimal treatment strategy for CSF shunt infection in pediatric patients with hydrocephalus? Methods The US National Library of Medicine and the Cochrane Database of Systematic Reviews were queried using MeSH headings and key words relevant to the objective of this systematic review. Abstracts were reviewed, after which studies meeting the inclusion criteria were selected and graded according to their quality of evidence (Classes I–III). Evidentiary tables were constructed that summarized pertinent study results, and based on the quality of the literature, recommendations were made (Levels I–III). Results A review and critical appraisal of 27 studies that met the inclusion criteria allowed for a recommendation for supplementation of antibiotic treatment using partial (externalization) or complete shunt hardware removal, with a moderate degree of clinical certainty. However, a recommendation regarding whether complete shunt removal is favored over partial shunt removal (that is, externalization) could not be made owing to severe methodological deficiencies in the existing literature. There is insufficient evidence to recommend the use of intrathecal antibiotic therapy as an adjunct to systemic antibiotic therapy in the management of routine CSF shunt infections. This also holds true for other clinical scenarios such as when an infected CSF shunt cannot be completely removed, when a shunt must be removed and immediately replaced in the face of ongoing CSF infection, or when the setting is ventricular shunt infection caused by specific organisms (for example, gram-negative bacteria). Conclusions Supplementation of antibiotic treatment with partial (externalization) or complete shunt hardware removal are options in the management of CSF shunt infection. There is insufficient evidence to recommend either shunt externalization or complete shunt removal as the preferred surgical strategy for the management of CSF shunt infection. Therefore, clinical judgment is required. In addition, there is insufficient evidence to recommend the combination of intrathecal and systemic antibiotics for patients with CSF shunt infection when the infected shunt hardware cannot be fully removed, when the shunt must be removed and immediately replaced, or when the CSF shunt infection is caused by specific organisms. The potential neurotoxicity of intrathecal antibiotic therapy may limit its routine use. Recommendation: Supplementation of antibiotic treatment with partial (externalization) or with complete shunt hardware removal is an option in the management of CSF shunt infection. Strength of Recommendation: Level II, moderate degree of clinical certainty. Recommendation: There is insufficient evidence to recommend either shunt externalization or complete shunt removal as a preferred surgical strategy for the management of CSF shunt infection. Therefore, clinical judgment is required. Strength of Recommendation: Level III, unclear degree of clinical certainty. Recommendation: There is insufficient evidence to recommend the combination of intrathecal and systemic antibiotics for patients with CSF shunt infection in whom the infected shunt hardware cannot be fully removed or must be removed and immediately replaced, or when the CSF shunt infection is caused by specific organisms. The potential neurotoxicity of intrathecal antibiotic therapy may limit its routine use. Strength of Recommendation: Level III, unclear degree of clinical certainty.

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Section: Arnell Et Al 2007mentioning

confidence: 99%

Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 8: Management of cerebrospinal fluid shunt infection

Tamber

Klimo

Mazzola

et al. 2014

PED

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“…Current treatments carry high risk for additional complications (Blount et al, 1993;Bondurant and Jimenez, 1995;Patwardhan and Nanda, 2005) and neurological problems often persist after treatment (Fernell et al, 1994;Mancao et al, 1998;Del Bigio, 2004). Understanding the causes of hydrocephalus is critical for developing new treatment and prevention options.…”

Section: Introductionmentioning

confidence: 99%

Development of Hydrocephalus in Mice Expressing the G_i-Coupled GPCR Ro1 RASSL Receptor in Astrocytes

Sweger¹,

Casper²,

Scearce‐Levie³

et al. 2007

J. Neurosci.

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We developed a transgenic mouse line that expresses the G i -coupled RASSL (receptor activated solely by synthetic ligand) Ro1 in astrocytes to study astrocyte-neuronal communication. Surprisingly, we found that all transgenics expressing Ro1 developed hydrocephalus. We analyzed these mice in an effort to develop a new model of hydrocephalus that will further our understanding of the pathophysiology of the disease. Expression of Ro1 was restricted to astrocytes by crossing the transgenic hGFAP-tTA (tet transactivator behind the human glial fibrillary acidic protein promoter) mouse line with the transgenic tetO-Ro1/tetO-LacZ mouse line. This cross produced double-transgenic mice that expressed Ro1 in astrocytes. All double transgenics developed hydrocephalus by postnatal day 15, whereas single-transgenic littermate controls appeared normal. Hydrocephalic Ro1 mice displayed enlarged ventricles, partial denudation of the ependymal cell layer, altered subcommissural organ morphology, and obliteration of the cerebral aqueduct. Severely hydrocephalic mice also had increased levels of phospho-Erk and GFAP expression. Administration of doxycycline to breeding pairs suppressed Ro1 expression and the onset of hydrocephalus in double-transgenic offspring. Ro1 animals maintained on dox did not develop hydrocephalus; however, if taken off doxycycline at weaning, double-transgenic mice developed enlarged ventricles within 7 weeks, indicating that Ro1 expression also induces hydrocephalus in adults. This study discovered a new model of hydrocephalus in which the rate of pathogenesis can be controlled enabling the study of the pathogenesis of both juvenile and adult onset hydrocephalus.

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“…Previous studies have identified a multitude of independent risk factors associated with shunt infection, including length of surgery, number of prior revisions, experience of the surgeon, etiology of hydrocephalus, patient age, immune status, and postoperative CSF leakage (1,10,12,18,19,27,28,30). Despite continued improvements in surgical and sterilization technique, perioperative antibiotic therapy, and appreciation of the aforementioned risk factors, significant reductions in infection rates remain elusive (10).…”

Section: Discussionmentioning

confidence: 97%

Cost Savings Associated with Antibiotic-Impregnated Shunt Catheters in the Treatment of Adult and Pediatric Hydrocephalus

Parker

McGirt

Murphy³

et al. 2015

World Neurosurgery

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Cerebrospinal fluid shunt infections in infants and children in Mobile, Alabama

Cited by 39 publications

References 9 publications

Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 8: Management of cerebrospinal fluid shunt infection

Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 8: Management of cerebrospinal fluid shunt infection

Development of Hydrocephalus in Mice Expressing the G_i-Coupled GPCR Ro1 RASSL Receptor in Astrocytes

Cost Savings Associated with Antibiotic-Impregnated Shunt Catheters in the Treatment of Adult and Pediatric Hydrocephalus

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Cerebrospinal fluid shunt infections in infants and children in Mobile, Alabama

Cited by 39 publications

References 9 publications

Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 8: Management of cerebrospinal fluid shunt infection

Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 8: Management of cerebrospinal fluid shunt infection

Development of Hydrocephalus in Mice Expressing the Gi-Coupled GPCR Ro1 RASSL Receptor in Astrocytes

Cost Savings Associated with Antibiotic-Impregnated Shunt Catheters in the Treatment of Adult and Pediatric Hydrocephalus

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Development of Hydrocephalus in Mice Expressing the G_i-Coupled GPCR Ro1 RASSL Receptor in Astrocytes