Duration of protective activity of cerebrospinal fluid shunt catheters impregnated with antimicrobial agents to prevent bacterial catheter-related infection

Bayston, Roger; Lambert, Emma

doi:10.3171/jns.1997.87.2.0247

Cited by 109 publications

(50 citation statements)

References 25 publications

(21 reference statements)

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“…The main aim of this impregnation process was protection against luminal colonisation, but the question of whether this catheter can also reduce the risk of external infections was not investigated. A follow-up in-vitro study showed an extension for up to 56 days in the protective activity of purely internal shunt colonisation [31]. However, to date, the ef®cacy of this catheter system in vivo has not been reported.…”

Section: Discussionmentioning

confidence: 99%

Use of scanning electron microscopy to investigate the prophylactic efficacy of rifampin-impregnated CSF shunt catheters

Kockro

Hampl

Jansen

et al. 2000

Journal of Medical Microbiology

113

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Infection continues to be one of the major complications of cerebrospinal¯uid (CSF) shunting procedures, and is caused mainly by skin-derived bacteria. Production of an extracellular bio®lm plays an important role in the pathogenesis of shunt-associated infections by protecting bacteria from immune mechanisms and antibiotics. So far, removal of the original shunt and implantation of a new shunting device has been the only successful treatment for most patients. As an alternative strategy to prevent CSF infections, a rifampin-impregnated silicone catheter was designed to provide high initial and long-lasting (>60 days) release of bactericidal drug. To investigate the pathophysiological mechanism of its function, this new device was investigated both in vitro and in a rodent model of CSF infection by scanning electron microscopy (SEM) and bacterial culture. Staphylococcus epidermidis (10 8 cfu=ml) and S. aureus (10 4 cfu=ml) served as test strains. SEM demonstrated that, in contrast to the unloaded catheters, initial bacterial adherence on the catheter surface could be reduced to a few single cells, which did not show visible signs of proliferation. Bacterial cultures obtained simultaneously were all sterile, showing that adherent bacteria were killed immediately by the rifampin released from the catheter. Although rifampin incorporation into silicone polymers was not able to prevent initial bacterial adhesion completely, subsequent colonisation could be prevented.

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Section: Discussionmentioning

confidence: 99%

Use of scanning electron microscopy to investigate the prophylactic efficacy of rifampin-impregnated CSF shunt catheters

Kockro

Hampl

Jansen

et al. 2000

Journal of Medical Microbiology

113

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“…These results remained consistent across all ages, shunt types, and pre-and postoperative durations of antibiotic use. 68 Recently introduced antibiotic-impregnated catheters (AICs) have been shown to decrease shunt colonization by Staphylococcus species, 3,30,35 though controversy remains whether their use should be standardized. Several nonrandomized studies showed a reduction in early shunt infection and hospital costs with their use.…”

Section: Infectionmentioning

confidence: 99%

Patterns in neurosurgical adverse events: cerebrospinal fluid shunt surgery

Wong¹,

Ziewacz

et al. 2012

FOC

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Object As part of a project to devise evidence-based safety interventions for specialty surgery, the authors sought to review current evidence in CSF shunt surgery concerning the frequency of adverse events in practice, their patterns, and the state of knowledge regarding methods for their reduction. This review may also inform future and ongoing efforts for the advancement of neurosurgical quality. Methods The authors performed a PubMed search using search terms “cerebral shunt,” “cerebrospinal fluid shunt,” “CSF shunt,” “ventriculoperitoneal shunt,” “cerebral shunt AND complications,” “cerebrospinal fluid shunt AND complications,” “CSF shunt AND complications,” and “ventriculoperitoneal shunt AND complications.” Only papers that specifically discussed the relevant complication rates were included. Papers were chosen to be included to maximize the range of rates of occurrence for the adverse events reported. Results In this review of the neurosurgery literature, the reported rate of mechanical malfunction ranged from 8% to 64%. The use of programmable valves has increased but remains of unproven benefit even in randomized trials. Infection was the second most common complication, with the rate ranging from 3% to 12% of shunt operations. A meta-analysis that included 17 randomized controlled trials of perioperative antibiotic prophylaxis demonstrated a decrease in shunt infection by half (OR 0.51, 95% CI 0.36–0.73). Similarly, use of detailed protocols including perioperative antibiotics, skin preparation, and limitation of OR personnel and operative time, among other steps, were shown in uncontrolled studies to decrease shunt infection by more than half. Other adverse events included intraabdominal complications, with a reported incidence of 1% to 24%, intracerebral hemorrhage, reported to occur in 4% of cases, and perioperative epilepsy, with a reported association with shunt procedures ranging from 20% to 32%. Potential management strategies are reported but are largely without formal evaluation. Conclusions Surgery for CSF shunt placement or revision is associated with a high complication risk due primarily to mechanical issues and infection. Concerted efforts aimed at large-scale monitoring of neurosurgical complications and consistent quality improvement within these highlighted realms may significantly improve patient outcomes.

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“…Based on the clinical predictivity of the tests used here in the case of other shunt pathogens (5,8,9,14,16,26,29), antimicrobial catheters promise to give protection against P. acnes shunt infection, extending from the perioperative to the immediate postoperative period, and are likely also to prevent late-presenting cases, as these are also contracted at initial surgery.…”

Section: Discussionmentioning

confidence: 99%

“…These are impregnated with rifampin and clindamycin (Bactiseal; Codman and Shurtleff, Inc., Raynham, MA) and provide a duration of activity of approximately 50 days (9). Bacterial colonization on both inner and outer surfaces is prevented (5).…”

mentioning

confidence: 99%

Activity of an Antimicrobial Hydrocephalus Shunt Catheter against Propionibacterium acnes

Bayston

Vera

Ashraf

2010

Antimicrob Agents Chemother

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Shunt infection is a major complication affecting approximately 10% of procedures. Propionibacterium acnes, an anaerobic skin bacterium, is increasingly recognized as a shunt pathogen, causing up to 14% of infections. Though susceptible to penicillin and cephalosporins, P. acnes shunt infections are not preventable by means of perioperative prophylaxis, due to poor cerebrospinal fluid penetration. Antimicrobial shunts with activity against staphylococci are available, but their activity against P. acnes is unknown, and the study was designed to determine this. Three methods of evaluation were used in order to determine the emergence of resistance when exposure is to high inocula for long periods, the time taken to kill 100% of the bacteria attached to the shunt, and the duration of activity under constant flow conditions with repeated bacterial challenge. Despite repeated exposure to high bacterial inocula over 70 days, no resistance was seen. The time taken to kill all attached bacteria, 96 h, was twice that taken to kill attached staphylococci. Nevertheless, under constant flow conditions with repeated challenges, the antimicrobial catheters resisted colonization by P. acnes for 56 days. Using tests that were designed to be clinically predictive when done together, the results suggest that the antimicrobial catheters will be able to prevent colonization of hydrocephalus shunts by P. acnes.Hydrocephalus is the pathological accumulation of cerebrospinal fluid (CSF) in the cerebral ventricles and is caused by a variety of factors, such as intrauterine infection, meningitis, hemorrhage, and tumors. The standard treatment is surgical insertion of a shunt, a silicone tubular device that drains CSF from the cerebral ventricles to another body site, usually the peritoneal cavity. Infection is a serious complication of shunting, the incidence ranging from less than 1% to over 15%, with an overall incidence of about 10% (13,18). Shunt infection in the United States has been estimated to account for more than $100 million in national health care expenditure annually (29). The causative bacteria are usually of skin origin, and coagulase-negative staphylococci (CoNS) predominate. However, a proportion of shunt infections, reported to be approximately 14%, is caused by Propionibacterium acnes, also a normal skin inhabitant (1,4,30). This organism is anaerobic and slow growing and often fails to be detected. Like CoNS, P. acnes adheres to the inner surfaces of the shunt catheters and develops a biofilm (4, 11), leading to antibiotic treatment failure and necessitating shunt removal.Although antimicrobial prophylaxis is almost universally used, its role in reducing the incidence of shunt infections remains controversial. Systemic antibiotics penetrate the blood-cerebrospinal fluid barrier poorly in the absence of inflammation (2,17,20,21,22). The use of intraventricular antibiotics to overcome this has not been successful (6, 32), with the possible exception of the combination of intraventricular gentamicin and vancomycin, wh...

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Duration of protective activity of cerebrospinal fluid shunt catheters impregnated with antimicrobial agents to prevent bacterial catheter-related infection

Cited by 109 publications

References 25 publications

Use of scanning electron microscopy to investigate the prophylactic efficacy of rifampin-impregnated CSF shunt catheters

Use of scanning electron microscopy to investigate the prophylactic efficacy of rifampin-impregnated CSF shunt catheters

Patterns in neurosurgical adverse events: cerebrospinal fluid shunt surgery

Activity of an Antimicrobial Hydrocephalus Shunt Catheter against Propionibacterium acnes

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