Comparison of Two Methods of Prophylaxis Against CSF Shunt Infection

Lambert, Michele P.; MacKinnon, A.E.; Vaishnav, Avirat

doi:10.1055/s-2008-1044298

Cited by 15 publications

(18 citation statements)

References 9 publications

(13 reference statements)

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“…34 However, because most studies are performed retrospectively and can be underpowered at single centers, they frequently arrive at opposing conclusions. Areas of ongoing controversy in the prevention of CSF shunt infection include the use of prophylactic IT antibiotics; 30,39,44,45 type of shunt; 31,46 antibiotic impregnated shunt tubing; 47–50 distal shunt location; 29,31,32,35,36,51 use of neuroendoscope; 12,34 duration of case; 34,36,40,51 case priority; 30,32,34,40 and people in the operating room. 34,39,40 In this study, none of the surgeon factors or medical and surgical decisions contributed substantially to infection risk beyond CSF shunt revision itself.…”

Section: Discussionmentioning

confidence: 99%

Revision Surgeries Are Associated With Significant Increased Risk of Subsequent Cerebrospinal Fluid Shunt Infection

Simon¹,

Whitlock

Riva-Cambrin

et al. 2012

Pediatric Infectious Disease Journal

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Background The object of this study was to determine if cerebrospinal fluid (CSF) shunt revision(s) are associated with increased risk of CSF shunt infection, after adjusting for baseline factors that contribute to infection risk. Methods This was a retrospective cohort study of 579 children ages 0 to 18 who underwent initial CSF shunt placement between 1/1/97 and 10/12/06 at a tertiary care children’s hospital. The outcome of interest was CSF shunt infection. Data for all subsequent CSF shunt revisions leading up to and including the initial CSF shunt infection, when applicable, were obtained. The likelihood of infection was determined using a Cox proportional hazard model accounting for patient characteristics and CSF shunt revisions, and is reported using hazard ratios (HR) with 95% confidence intervals (CI). Results There were 123 children who developed infection. Baseline factors independently associated with hazard of infection included age 0 to <6 months at CSF shunt placement (HR 2.4, 95% CI: 1.02, 6.7) and myelomeningocele (HR 0.4, 95% CI: 0.2, 0.8). Controlling for baseline factors, the risk of infection after shunt revision was significantly greater than at the time of initial placement (HR 3.0, 95% CI: 1.9, 4.7), and this risk increased as numbers of revisions increased (≥2 revisions HR 6.5, 95% CI: 3.6, 11.4). Conclusions While younger age is associated with increased hazard of infection, subsequent CSF shunt revision significantly increases infection risk.

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Section: Discussionmentioning

confidence: 99%

Revision Surgeries Are Associated With Significant Increased Risk of Subsequent Cerebrospinal Fluid Shunt Infection

Simon¹,

Whitlock

Riva-Cambrin

et al. 2012

Pediatric Infectious Disease Journal

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“…6,7 Because CNS infections after shunting procedures are responsible for substantial mortality and morbidity, especially in children, the possible role of prophylactic antimicrobials in such procedures has been studied in numerous small, well-conducted, randomized controlled trials. [564][565][566][567][568][569][570][571] Meticulous surgical and aseptic techniques and short procedure times were determined to be important factors in lowering infection rates after shunt placement. Although the number of patients studied in each trial was small, two meta-analyses of these data demonstrated that antimicrobial prophylaxis use in CSF-shunting procedures reduced the risk of infection by approximately 50%.…”

Section: Neurosurgery Proceduresmentioning

confidence: 99%

Clinical practice guidelines for antimicrobial prophylaxis in surgery

Bratzler

Dellinger

Olsen

et al. 2013

American Journal of Health-System Pharmacy

1,839

1,464

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“…This investigation underlines the problem with too low a number of patients [41] which seems to be a general feature in most negative studies of prophylactic antibiotics [3,26,55].…”

Section: Prophylaxis Against Infectionsmentioning

confidence: 98%

Risk of infection after cerebrospinal fluid shunt: An analysis of 884 first-time shunts

et al. 1995

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Postoperative infections are major complications of cerebrospinal fluid (CSF) shunting in the treatment of hydrocephalus and other conditions with obstructed CSF circulation. In a retrospective study 884 first-time shunted patients with hydrocephalus operated on in the years 1958-1989 were investigated with special reference to the infection rate and to the influence of the following variables: time period, age of the patient, education of the neurosurgeon, length and time of the operation and the exact placement of the distal drain. The overall infection rate for all implanted CSF shunts was 7.4% (5.7-9.3%) and the acute rate of infection was 6.2% (4.6-7.9%). The rate of infection was virtually constant for all variables with the exception of the education of the neurosurgeon. Neurosurgical trainees particularly had a significantly higher rate of infection. Shunt infection is still a major complication. The infection rate has not declined in recent decades. It is not possible to relate any main cause to the infection rate. The literature recommends removal of the infected shunt combined with antibiotics. The use of prophylactic antibiotics is still controversial. No prospective, double-blind studies, including a sufficiently large number of patients to evaluate this issue, exist today.

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Comparison of Two Methods of Prophylaxis Against CSF Shunt Infection

Cited by 15 publications

References 9 publications

Revision Surgeries Are Associated With Significant Increased Risk of Subsequent Cerebrospinal Fluid Shunt Infection

Revision Surgeries Are Associated With Significant Increased Risk of Subsequent Cerebrospinal Fluid Shunt Infection

Clinical practice guidelines for antimicrobial prophylaxis in surgery

Risk of infection after cerebrospinal fluid shunt: An analysis of 884 first-time shunts

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