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

Abstract

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.

2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis*

“…Use of antimicrobial-impregnated shunts has not only reduced the incidence of CSF shunt infections but also has resulted in significant hospital cost savings [181]. In a study that compared the effectiveness of antimicrobial-impregnated shunt catheters in treatment of 12 589 consecutive cases from 287 hospital systems in adult and pediatric patients with hydrocephalus [182], antimicrobial-impregnated catheter use was associated with a significant reduction in infection in both adult (2.2% vs 3.6%; P = .02) and pediatric (2.6% vs 7.1%; P < .01) patients. Reduced infection was demonstrated regardless of hospital size, annual shunt volume, hospital location, or patient risk factors.…”

Neurosurgical Infections

“…Cost analysis studies have demonstrated that use of the more expensive impregnated catheters is supported. 51,55 The most recent guidelines from the Infectious Diseases Society of America's Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis recommend placement of antibiotic-impregnated shunts. 28 However, the largest international, prospective, randomized trial of 434 patients failed to find a significant benefit to the use of antibiotic-impregnated catheters, with a 2.3% infection rate for impregnated catheters compared with a 2.8% infection rate for standard catheters.…”

Prevención y tratamiento de las infecciones del sitio operatorio en neurocirugía. Estado del arte

“…Las revisiones sistemáticas disponibles favorecen su utilización, sin diferenciar entre los recubiertos por clindamicina o minociclina con rifampicina, al encontrar reducción neta estadísticamente significativa del riesgo de infección. Lo anterior es aplicable a todos los grupos de edad evaluados (neonatos, población pediátrica y adulta) con una reducción más evidente en la infección causada por Staphylococcus spp (25)(26)(27)(28)(29)(30)(31)(32)(33) . No obstante, también existen estudios que no encuentran diferencia en la ocurrencia de infección con el uso de estos dispositivos y no recomiendan su uso (34,35) , aunque la IDSA los recomienda (7) .…”