Abstract:Despite wide variation in compliance rates, the implementation of comprehensive surgical protocols reduced shunt infection in all published studies. Antibiotic-impregnated suture, a no-shave policy, double gloving with glove change prior to device manipulation, and 5 % chlorhexidine hair wash were associated with significant reductions in shunt infection.
“…Preoperative intravenous (iv) prophylactic antibiotics are administered routinely and this is a mainstay of prevention [ 10 ]. Many different measures appear to contribute to reducing the shunt infection rate, although evidence for each separate measure is minimal or nonexistent [ 11 ]. Combining of all these measures into an institutional shunt infection prevention protocol is the most effective means of preventing shunt infections [ 5 ].…”
ObjectDespite many efforts at reduction, cerebrospinal fluid (CSF) shunt infections are a major cause of morbidity in shunt surgery, occurring in 5–15% of cases. To attempt to reduce the shunt infection rate at our institution, we added topical vancomycin (intrashunt and perishunt) to our existing shunt infection prevention protocol in 2012.MethodsWe performed a retrospective cohort study comparing all shunted patients in January 2010 to December 2011 without vancomycin (control group, 263 procedures) to all patients who underwent shunt surgery between April 2012 and December 2015 with vancomycin (intervention group, 499 procedures).ResultsThe overall shunt infection rate significantly decreased from 6.8% (control group) to 3.0% (intervention group) (p = 0.023, absolute risk reduction 3.8%, relative risk reduction 56%). Multivariate logistic regression analysis confirmed that the addition of topical vancomycin showed that cases treated under a protocol of topical vancomycin were associated with a decreased shunt infection rate (odds ratio [OR] 0.49 95% CI 0.25–0.998; p = 0.049). Age < 1 year was associated with an increased risk of infection (OR) 4.41, 95% CI 2,10–9,26; p = 0.001). Time from surgery to infection was significantly prolonged in the intervention group (p = 0.001).ConclusionAdding intraoperative vancomycin to a shunt infection prevention protocol significantly reduces CSF shunt infection rate.
“…Preoperative intravenous (iv) prophylactic antibiotics are administered routinely and this is a mainstay of prevention [ 10 ]. Many different measures appear to contribute to reducing the shunt infection rate, although evidence for each separate measure is minimal or nonexistent [ 11 ]. Combining of all these measures into an institutional shunt infection prevention protocol is the most effective means of preventing shunt infections [ 5 ].…”
ObjectDespite many efforts at reduction, cerebrospinal fluid (CSF) shunt infections are a major cause of morbidity in shunt surgery, occurring in 5–15% of cases. To attempt to reduce the shunt infection rate at our institution, we added topical vancomycin (intrashunt and perishunt) to our existing shunt infection prevention protocol in 2012.MethodsWe performed a retrospective cohort study comparing all shunted patients in January 2010 to December 2011 without vancomycin (control group, 263 procedures) to all patients who underwent shunt surgery between April 2012 and December 2015 with vancomycin (intervention group, 499 procedures).ResultsThe overall shunt infection rate significantly decreased from 6.8% (control group) to 3.0% (intervention group) (p = 0.023, absolute risk reduction 3.8%, relative risk reduction 56%). Multivariate logistic regression analysis confirmed that the addition of topical vancomycin showed that cases treated under a protocol of topical vancomycin were associated with a decreased shunt infection rate (odds ratio [OR] 0.49 95% CI 0.25–0.998; p = 0.049). Age < 1 year was associated with an increased risk of infection (OR) 4.41, 95% CI 2,10–9,26; p = 0.001). Time from surgery to infection was significantly prolonged in the intervention group (p = 0.001).ConclusionAdding intraoperative vancomycin to a shunt infection prevention protocol significantly reduces CSF shunt infection rate.
“…Shunt failure rates remain relatively high despite significant advances in shunt technology, and the shunt revision‐to‐insertion ratio is 3‐to‐1 at many health‐care centers . Shunt infection is considered one of the leading causes of shunt failure, with a reported incidence of 5–20% according to both earlier and more recent studies . Shunt infection also causes morbidity and mortality, and results in high health‐care costs.…”
mentioning
confidence: 99%
“…2,3 Shunt infection is considered one of the leading causes of shunt failure, with a reported incidence of 5-20% according to both earlier and more recent studies. 2,[4][5][6][7] Shunt infection also causes morbidity and mortality, and results in high health-care costs. Shunt infection accounts for 2,400 admissions and 59 000 hospital days annually in the USA.…”
Background
The aim of this study was to identify independent risk factors for cerebrospinal fluid shunt infection.
Methods
The medical records of all patients aged 0–18 years who underwent shunt‐related surgery for the treatment of hydrocephalus at the present institution between January 1996 and December 2015 were reviewed. For each case, two randomly selected controls with no shunt infection, matched for year of surgery, were chosen. Demographic clinical and microbiological data were abstracted.
Results
A total of 1,570 shunt‐related procedures met the inclusion criteria, yielding 68 infections (in 63 patients). The control group consisted of 132 infection‐free patients. The average annual infection rate was 4.2% cases per year. The median time between shunt procedures to infection was 19 days (range, 1–2,181). On multivariate analysis, risk factors associated with increased risk for developing an infection included a history of two or more previous revisions (OR, 4.8; 95%CI: 1.5–15.9); and age <5 years (OR, 4.5; 95%CI 1.5–13.4). A neoplastic etiology for hydrocephalus was found to be a protective factor for shunt infection (P = 0.001).
Conclusions
A history of shunt revision was the most significant risk factor in the development of subsequent shunt infection. Age >5 years was a protective factor. Future efforts should focus on modalities to optimize revision procedures and reduce the risk of subsequent infection.
“…Las investigaciones en este punto se centran en el uso de protocolos estandarizados para el posicionamiento, manutención y manipulación de drenes y derivaciones; en la administración profiláctica de antibióticos sistémicos y/o tópicos; en el uso de derivaciones y drenajes impregnados de antibiótico o iones de plata y en evitar el cambio de drenes externos en intervalos fijos (7,20) . Cabe mencionar la efectividad de las medidas generales de prevención, como el lavado de manos, el control de la glicemia del paciente, el mantenimiento del aire limpio en el quirófano, la implementación rigurosa de protocolos de asepsia y antisepsia para la preparación del paciente, el uso de instrumental estéril y la disciplina del equipo quirúrgico (18) .…”
Section: Prevención De La Infección Del Sitio Operatoriounclassified
“…Los protocolos quirúrgicos integrales, que incluyen los protocolos de mínima manipulación de dispositivos médicos en los diferentes estudios, han mostrado una reducción de la tasa de ISO y del recambio de dispositivos, pese a los diferentes rangos de adhesión del personal de salud (20) . Las intervenciones que incluyen los protocolos son: uso de suturas impregnadas de antibiótico, política del no rasurado, uso de doble guante, cambio de guantes previamente a la manipulación de dispositivos, lavado del cabello con clorhexidina al 5 %, tunelización subcutánea extensa con colocación de apósitos de hidrocoloides para la protección de las suturas de fijación del dispositivo, mínima manipulación de los dispositivos, toma de muestras de LCR cuando es estrictamente necesario y recolección de LCR por goteo y no por aspirado, para evitar la obstrucción del sistema (20,(21)(22)(23)(24) .…”
El manejo adecuado de las infecciones del sitio operatorio (ISO) en neurocirugía es fundamental para la disminución de la carga de morbilidad y mortalidad en estos pacientes.La sospecha y confirmación diagnóstica asociadas al aislamiento microbiológico son esenciales para asegurar el tratamiento oportuno y el adecuado gerenciamiento de antibióticos. En esta revisión se presenta de forma resumida los puntos fundamentales para la prevención y el tratamiento de infecciones del sitio operatorio en neurocirugía y se incluye un apartado sobre el uso de antibióticos intratecales/intraventriculares.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.