Epidemiology, Prevention and Management of Ventriculoperitoneal Shunt Infections in Children

Prusseit, Julia; Simon, Matthias; Brelie, Christian von der; Heep, Axel; Molitor, Ernst; Völz, Sebastian; Simon, Arne

doi:10.1159/000257520

Cited by 118 publications

(74 citation statements)

References 214 publications

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“…Patient age and the etiology of hydrocephalus have been reported to be associated with outcomes after ETV 4,5,7,20,22,23,25,26,30) . Interestingly, the results are different when ETV is performed after shunt failure (secondary ETV) than when ETV is performed as an initial treatment modality for hydrocephalus (primary ETV).…”

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confidence: 99%

Endoscopic Third Ventriculostomy in Patients with Shunt Malfunction

Lee

Kong

Seol

et al. 2011

J Korean Neurosurg Soc

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Objective : This paper presents data from a retrospective study of endoscopic third ventriculostomy (ETV) in patients with shunt malfunction and proposes a simple and reasonable post-operative protocol that can detect ETV failure. Methods : We enrolled 19 consecutive hydrocephalus patients (11 male and 8 female) who were treated with ETV between April 2001 and July 2010 after failure of previously placed shunts. We evaluated for correlations between the success rate of ETV and the following parameters : age at the time of surgery, etiology of hydrocephalus, number of shunt revisions, interval between the initial diagnosis of hydrocephalus or the last shunt placement and ETV, and the indwelling time of external ventricular drainage. Results : At the time of ETV after shunt failure, 14 of the 19 patients were in the pediatric age group and 5 were adults, with ages ranging from 14 months to 42 years (median age, 12 years). The patients had initially been diagnosed with hydrocephalus between the ages of 1 month 24 days and 32 years (median age, 6 years 3 months). The etiology of hydrocephalus was neoplasm in 7 patients; infection in 5; malformation, such as aqueductal stenosis or megacisterna magna in 3; trauma in 1; and unknown in 3. The overall success rate during the median follow-up duration of 1.4 years (9 days to 8.7 years) after secondary ETV was 68.4%. None of the possible contributing factors for successful ETV, including age (p=0.97) and the etiology of hydrocephalus (p=0.79), were statistically correlated with outcomes in our series. Conclusion : The use of ETV in patients with shunt malfunction resulted in shunt independence in 68.4% of cases. Age, etiology of hydrocephalus, and other contributing factors were not statistically correlated with ETV success. External ventricular drainage management during the immediate post-ETV period is a good means of detecting ETV failure.

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Endoscopic Third Ventriculostomy in Patients with Shunt Malfunction

Lee

Kong

Seol

et al. 2011

J Korean Neurosurg Soc

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“…13,22,25,32,37,39 The rate of shunt infection reported varies considerably in the literature, but in recent studies the incidence typically ranges from 5% to 15%, with rates typically higher in high-risk groups such as preterm neonates and patients recently treated for shunt infection. 28,33,34,36,42 Evidence of a shunt infection often manifests within 2 months after surgery. Infections are typically caused by gram-positive opportunistic pathogens that colonize the skin of the patient such as coagulase-negative Staphylococcus, S. epidermidis, and S. aureus.…”

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confidence: 99%

“…Infections are typically caused by gram-positive opportunistic pathogens that colonize the skin of the patient such as coagulase-negative Staphylococcus, S. epidermidis, and S. aureus. 28 The administration of preoperative antibiotic agents, typically those providing gram-positive coverage such as a first-generation cephalosporin, nafcillin, clindamycin, or vancomycin, has been demonstrated or is assumed to lower the infection rate for all major cranial and spinal neurosurgical procedures. [4][5][6] Numerous studies, including 3 meta-analyses, 21,24,29 have investigated the use of preoperative antibiotics as prophylaxis against shunt infection, both for adult and pediatric patients.…”

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confidence: 99%

Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 6: Preoperative antibiotics for shunt surgery in children with hydrocephalus: a systematic review and meta-analysis

Klimo

Poppel

Thompson

et al. 2014

PED

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Object The objective of this systematic review and meta-analysis was twofold: to answer the question “What is the evidence for the effectiveness of prophylactic intravenous antibiotics for infection prevention in shunt surgery?” and to make treatment recommendations based on the available evidence. Methods The US National Library of Medicine PubMed/MEDLINE database and the Cochrane Database of Systematic Reviews were queried using MeSH headings and key words relevant to prophylactic antibiotic use in children undergoing a shunt operation. Abstracts were reviewed to identify which studies met the inclusion criteria. An evidentiary table was assembled summarizing the studies and the quality of evidence (Classes I-III). A meta-analysis was conducted using a random-effects model to calculate a cumulative estimate of treatment effect using risk ratio (RR). Heterogeneity was assessed using chi-square and I2 statistics. A sensitivity analysis was also conducted. Based on the quality of the literature and the result of the meta-analysis, a recommendation was rendered (Level I, II, or III). Results Nine studies (4 Class I, 3 Class II, and 2 Class III) met our inclusion criteria. Of 7 randomized controlled trials (RCTs), 3 were downgraded from Class I to Class II because of significant quality issues, and all RCTs were potentially underpowered. In only 2 Class in retrospective cohort studies were preoperative antibiotic agents found to be protective against shunt infection. When data from the individual studies were pooled together, the infection rate in the prophylactic antibiotics group was 5.9% compared with 10.7% in the control group. Using a random-effects model, the cumulative RR was 0.55 (95% CI 0.38–0.81), indicating a protective benefit of prophylactic preoperative intravenous antibiotics. A sensitivity analysis of RCTs only (n = 7) also demonstrated a statistical benefit, but an analysis of higher-quality RCTs only (n = 4) did not. Conclusions Within the limits of this systematic review and meta-analysis, administration of preoperative antibiotic agents for shunt surgery in children was found to lower the infection risk (quality of evidence: Class II; strength of recommendation, Level II). Recommendation The use of preoperative antibiotic agents can be recommended to prevent shunt infection in patients with hydrocephalus. It was only by combining the results of the various underpowered studies (meta-analysis) that the use of preoperative antibiotics for shunt surgery in children was shown to lower the risk of shunt infection. Strength of Recommendation: Level II, moderate degree of clinical certainty.

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“…iken ventrikülo-atriyal (VA) şantlarda hematojen yolla (bakteriyemi vb.) şanta ulaşırlar (17). Distal ucun infekte olması sonrasında mikroorganizmalar retrograd yolla ilerleyerek şantın proksimal bölümlerine ulaşabilirler.…”

Section: Patogenezunclassified

Cerebrospinal Fluid Shunt Infections

Öncü¹

2010

Klimik Dergisi

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ÖzetHidrosefali tedavisinde kullanılan medikal ve cerrahi tedaviler arasında şant, uygulaması en çok tercih edilendir. Beyin-omurilik sıvısı (BOS), şant ile vücut dışına ya da seröz boşluklardan birine yönlendirilerek kafaiçi basıncının azaltılması sağlanmaktadır. Bu cihazların kullanımı sırasında ortaya çıkabilecek komplikasyonlardan biri şantın infeksiyonudur. Ortalama %5-15 sıklığında saptanan şant infeksiyonlarına neden olan etkenler çoğunlukla deri normal fl orasından kaynaklanmaktadır. Cerrahi işlem sıra-sında veya yara iyileşmesi sürecinde mikroorganizmaların şanta bulaşması infeksiyon gelişmesinde en bilinen yoldur. Hastada saptanan klinik belirtiler kullanılan şant tipine göre farklılıklar gösterebilmektedir. Ventrikülo-peritoneal (VP) şant infeksiyonunda karın ağrısı ön planda iken, ventrikülo-atriyal (VA) şant infeksiyonunda ateş en belirgin belirtidir. Şant infeksiyonu düşü-nülen hastalarda BOS'un hücresel, biyokimyasal ve mikrobiyolojik analizleri yapılmalıdır. İnfeksiyon tanısı konulan hastalarda antibiyotik tedavisi ile birlikte şantın revizyonu altın standard yaklaşımdır. Sistemik antibiyotik tedavisi yanında indikasyonu olan vakalarda intraventriküler antibiyotik uygulanması söz konusudur. Şant infeksiyonlarından korunmanın en etkili yolu, cerrahi alan infeksiyonlarını önlemek için gerekli prensiplere maksimum düzeyde uyulmasıdır. Klimik Dergisi 2010; 23(3): 77-82.Anahtar Sözcükler: Beyin-omurilik sıvısı şantları, infeksiyon. AbstractShunt is the most common approach among medical and surgical treatment modalities for treating hydrocephalus. The main purpose of the shunt is to reduce intracranial pressure by draining the cerebrospinal fl uid (CSF) from the ventricles. Infection is one of the serious complications and it develops in approximately 5-15% of the inserted devices. The microorganisms responsible for the shunt infection usually arise from the normal fl ora of the skin. During the surgical procedure and healing period, microorganisms residing in skin may adhere to the shunt and start the infection. The clinical symptoms may differ according to the type of shunt used. Abdominal pain is the most common complaint in patients with infected ventriculo-peritoneal (VP) shunt. On the other hand, fever is the leading symptom in ventriculo-atrial (VA) shunt infection. Other than clinical signs, biochemical and microbiological analysis of CSF are necessary to diagnose shunt infection. The gold standard of treatment is the usage of antibiotics with shunt revision. In addition to parenteral antibiotics, intraventricular administration of antibiotics may be an essential part of the treatment. The most effi cient way to avoid shunt infection is to follow the strict rules for preventing surgical site infections.

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Epidemiology, Prevention and Management of Ventriculoperitoneal Shunt Infections in Children

Cited by 118 publications

References 214 publications

Endoscopic Third Ventriculostomy in Patients with Shunt Malfunction

Endoscopic Third Ventriculostomy in Patients with Shunt Malfunction

Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 6: Preoperative antibiotics for shunt surgery in children with hydrocephalus: a systematic review and meta-analysis

Cerebrospinal Fluid Shunt Infections

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