Effect of antibiotic-impregnated shunt catheters in decreasing the incidence of shunt infection in the treatment of hydrocephalus

Sciubba, Daniel M.; Stuart, R. Morgan; McGirt, Matthew J.; Woodworth, Graeme F.; Samdani, Amer F.; Carson, Benjamin S.; Jallo, George I.

doi:10.3171/ped.2005.103.2.0131

Cited by 70 publications

(61 citation statements)

References 48 publications

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“…There is evidence that antibiotic-impregnated catheters can reduce the incidence of meningitis in adult patients with EVDs, 24 and this information has been extrapolated to pediatric patients in many centers. There is weak evidence that antibiotic-impregnated catheters can reduce the rate of shunt infection, 8,17,23 although the results are mixed. 10,19 An ongoing study of a shunt surgery infection protocol has initial promising results, and is one of the many strategies that are needed to reduce the incidence of shunt infection.…”

Section: Discussionmentioning

confidence: 99%

Prospective surveillance of complications in a pediatric neurosurgery unit

Drake

Riva-Cambrin

Jea

et al. 2010

PED

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Object Complications of specific pediatric neurosurgical procedures are well recognized. However, focused surveillance on a specific neurosurgical unit, for all procedures, may lead to better understanding of the most important complications, and allow targeted strategies for quality improvement. Methods The authors prospectively recorded the morbidity and mortality events at a large pediatric neurosurgical unit over a 2-year period. Morbidity was defined as any significant adverse outcome or death (for obstructive shunt failure, within 30 days). Multiple and unrelated complications in the same patient were recorded as separate events. Results There were 1082 surgical procedures performed during the evaluation period. One hundred seventy-seven complications (16.4%) occurred in 147 patients. By procedure, the most common complications occurred in vascular surgery (41.7%) and brain tumor surgery (27.9%). The most common complications were CSF leakage (31 cases), a new neurological deficit (27 cases), early shunt or endoscopic third ventriculostomy obstruction (27 cases), and shunt infection (24 cases). Meningitis occurred in 19 cases: in 58% of shunt infections, 13% of CSF leaks, and 10% of wound infections. Sixty-four percent of adverse events required a second procedure, most commonly an external ventricular drain placement or shunt revision. Conclusions Complications in pediatric neurosurgical procedures are common, result in significant morbidity, and more than half the time require a repeat surgical procedure. Targeted strategies to prevent common complications, such as shunt infections or CSF leaks, might significantly reduce this burden.

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Section: Discussionmentioning

confidence: 99%

Prospective surveillance of complications in a pediatric neurosurgery unit

Drake

Riva-Cambrin

Jea

et al. 2010

PED

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“…Total shunt revision in our series represented 58.1% of shunt procedures which is much higher than the result of Naftel et Shunt-related infections represent 2 to 27% of total shunt procedures (8,15,18,21,22,28,27,30). Shunt revision due to shunt related infection in our study represented 11.22% of the total cases which is slightly higher than the result of Kulkarni et al (26) who reported 10% infection rate after VPS insertion but less than the results of Kinasha et al (13) who reported 24.6% shunt related infection but overall in our elective neurosurgical procedures the incidence of shunt related infection is still accepted.…”

Section: Discussionmentioning

confidence: 46%

Laparoscopic revision of the distally obstructed ventriculoperitoneal shunt

Abouhashem

Taha²,

Ismail³

et al. 2012

Turkish Neurosurgery

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AIm: Evaluation of the laparoscopic assisted revision of the ventriculoperitoneal shunt as an alternative technique to the traditional laparotomy. mAterIAl and methOds: Out of 1181 elective neurosurgical procedures have been done from January 2009 to December 2010. There are 98 (8.2%) ventriculoperitoneal shunt procedures. New shunt insertion was performed 41 times (41.9%) and shunt revision performed 57 times (58.1%). Shunt-related infection was detected in 11 cases (11.22%) while mechanical failure was found in 46 cases (46.9%), proximal obstruction was diagnosed in 26 cases (26.5 %) while 20 patients (20.4%) suffered from distal obstruction. Out of the 20 patients with distal obstruction, 12 patients were treated with laparoscopic assisted revision of the peritoneal end.results: Intra operative finding revealed peritoneal adhesion in 83.3% of cases and cerebrospinal fluid pseudo cyst in 16.6% while extra peritoneal tube was found in one case. Intraoperative management included adhesiolysis in 10 patient, evacuation and marsupialization of the cyst in two cases in addition to tube repositioning in all cases. There was no procedure-related complications.COnClusIOn: Laparoscopic assisted revision of the peritoneal catheter is an alternative technique to traditional laparotomy in the revision of ventriculoperitoneal shunt.

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“…However, they also reported the absence of any staphylococci in any of their AIS infections, which was in contrast to other published reports. In a retrospective review, Sciubba et al reported a 2.4-fold diminished pediatric shunt infection percentage when changing from standard to impregnated catheters with a follow-up period of 6 months (14). A statistically significant diminution of 6.5% to 1.2% in infection rates has also been stated by Pattavilakom et al (16).…”

Section: Discussionmentioning

confidence: 67%

“…On the other hand, their clinical effectiveness in drastically reducing shunt infections in clinical practice is doubtful and there remains a reluctance to apply AIS catheters because of their increased price not unavoidably translating into obvious patient advantage (14,15). There have been several studies with varying conclusions reported in the literature.…”

Section: Discussionmentioning

confidence: 91%

The impact of antibiotic-impregnated catheters on ventriculoperitoneal shunt infection

Sorar¹,

Er²,

Özişik³

et al. 2014

Turk J Med Sci

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Previous studies on in vitro rooting for improved micropropagation of eucalypts indicated that root graviperception and postacclimatisation architecture are determined by the relative exogenous auxin analogue and its stability, supplied during the pre-rooting culture stages. The specific roles of indole-3-acetic acid (IAA) and indole-3-butyric acid (IBA) in the rooting medium on the in vitro root morphological processes were explored using a good-rooting clone. In vitro rooting percentage was significantly reduced when either of the auxin inhibitors 2,3,5-triiodobenzoic acid (TIBA) and ρ-chlorophenoxyisobutyric acid (PCIB) or the auxin antagonist kinetin was supplied at rooting, with or without exogenous auxin. For all treatments, at the time of root induction, shoots did not possess a vascular cambium, only procambial tissue, from where adventitious roots formed. However, when the inhibitors or the antagonist were supplied to the roots 3 days after root induction, they affected root growth and graviperception. Kinetin and PCIB significantly reduced the mean root diameter from 552.8 µm (control) to 129.2 µm and 278.6 µm, respectively, over 3 weeks. While the PCIB treatment resulted in a significant increase in Δ root length over this period, the TIBA treatment significantly decreased ∆ root length and increased mean root diameter to 833.4 µm. Restricting IAA transport with TIBA further altered root vascular patterning and, as with PCIB, resulted in the collapse of the columella region. Nevertheless, only a disruption in IAA transport and subsequent auxin distribution by TIBA treatment resulted in altered root graviperception. The results suggest the necessary inclusion of IAA in eucalypt micropropagation protocols to ensure good quality roots.

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Effect of antibiotic-impregnated shunt catheters in decreasing the incidence of shunt infection in the treatment of hydrocephalus

Abstract: The AIS catheter significantly reduced incidence of CSF shunt infection in children with hydrocephalus during the early postoperative period (< 6 months). The AIS system used is an effective instrument to prevent perioperative colonization of CSF shunt components.

Cited by 70 publications

References 48 publications

Prospective surveillance of complications in a pediatric neurosurgery unit

Prospective surveillance of complications in a pediatric neurosurgery unit

Laparoscopic revision of the distally obstructed ventriculoperitoneal shunt

The impact of antibiotic-impregnated catheters on ventriculoperitoneal shunt infection

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