Hospital Costs Associated With Shunt Infections in Patients Receiving Antibiotic-Impregnated Shunt Catheters Versus Standard Shunt Catheters

Attenello, Frank J.; Garces-Ambrossi, Giannina; Zaidi, Hasan A.; Sciubba, Daniel M.; Jallo, George I.

doi:10.1227/01.neu.0000363405.12584.4d

Cited by 87 publications

(55 citation statements)

References 37 publications

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“…This topic has been a source of great debate among neurosurgeons, and a plethora of medical literature has been published on this topic. 1,5,31,45,48,52 We found a borderline significant association (p = 0.12) between the use of antibiotic-impregnated catheters and a reduction in shunt infection in the univariate analysis. However, this correlation did not persist in the multivariate analysis.…”

Section: Variables Associated With Infection In Previous Studiesmentioning

confidence: 66%

Reduction in CSF shunt infection over a 10-year period associated with the application of concentrated topical antibiotic powder directly to surgical wounds prior to closure

Beckman

Amankwah²,

Tetreault

et al. 2015

PED

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OBJECT The application of concentrated topical antibiotic powder directly to surgical wounds has been associated with a reduction in wound infection in cardiac, spinal, and deep brain stimulator surgery. As a result of these findings, the corresponding author began systematically applying concentrated bacitracin powder directly to wounds during shunt surgery more than 5 years ago. The object of this study was to evaluate the effectiveness of concentrated bacitracin powder applied directly to wounds prior to closure during cranial shunt surgery and to evaluate the association between shunt infection and other risk factors. A single surgeon’s cranial shunt surgery experience, equally divided between periods during which antibiotic powder was and was not applied, was studied to assess the effect of concentrated bacitracin powder application on shunt infection rates. METHODS This retrospective cohort study included all patients who underwent a cranial shunting procedure at All Children’s Hospital performed by a single surgeon (G.F.T.) from 2001 to 2013. The surgeon applied bacitracin powder to all shunt wounds prior to closure between 2008 and 2013, whereas no antibiotic powder was applied to wounds prior to 2008. Both initial and revision shunting procedures were included, and all procedures were performed at a large children’s hospital (All Children’s Hospital). The primary outcome measure was shunt infection, which was defined using clinical criteria previously used by the Hydrocephalus Clinical Research Network. The association between bacitracin powder use and shunt infection was estimated using hazard ratios (HRs) and 95% CIs from Cox proportional hazard regression models. RESULTS A total of 47 infections out of 539 shunt operations occurred during the study period, resulting in an overall infection rate of 8.7%. Procedures performed before the use of concentrated bacitracin powder was instituted resulted in a 13% infection rate, whereas procedures performed after systematic use of bacitracin powder had been adopted experienced a 1% infection rate. Bacitracin powder use was associated with a reduced risk of shunt infection in univariate analysis (HR 0.11, 95% CI 0.03–0.34, p = 0.0002) and also in multivariate analysis (HR 0.12, 95% CI 0.04–0.41, p = 0.0006) when controlling for covariates that were associated with infection from the univariate analysis. The presence of a tracheostomy or a gastrostomy tube was also found to be independently associated with shunt infection in multivariate analysis (HR 3.15, 95% CI 1.05–9.50, p = 0.04, and HR 2.82, 95% CI 1.33–5.96, p = 0.007, respectively). CONCLUSIONS This study suggests, for the first time, that the systematic application of concentrated bacitracin powder to surgical wounds prior to closure during shunt surgery may be associated with a reduction in cranial shunt infection. This initial finding requires validation in a large prospective study before widespread application can be advocated.

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Section: Variables Associated With Infection In Previous Studiesmentioning

confidence: 66%

Reduction in CSF shunt infection over a 10-year period associated with the application of concentrated topical antibiotic powder directly to surgical wounds prior to closure

Beckman

Amankwah²,

Tetreault

et al. 2015

PED

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“…17 In the scenarios of 8 and then 10 revisions, shown only for shunts, the trend is further established. While 10 revisions are presented as an extreme scenario, there have been reports of adult patients with PTC needing even more, which extends the increasing cost trend for patients with higher revision shunts.…”

Section: Total Revisions Per Patientmentioning

confidence: 81%

Transverse Sinus Stenting for Pseudotumor Cerebri: A Cost Comparison with CSF Shunting

Ahmed¹,

Zmudzki²,

Parker

et al. 2013

American Journal of Neuroradiology

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BACKGROUND AND PURPOSE:Transverse sinus venous stent placement has been shown to lower intracranial pressure in patients with venogenic pseudotumor cerebri and to reverse, or at least stabilize, its symptoms and signs. There have been no studies comparing the cost of venous stenting with the time-honored treatment for pseudotumor cerebri-CSF shunting. The purpose of this study was to compare the cost of trasverse sinus stenting versus CSF shunting for the treatment of pseudotumor cerebri.

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“…3,15,35 The clinical consequences of a shunt infection include seizures, psychomotor retardation, reduced intelligence quotient, and increased mortality. 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.…”

mentioning

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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Hospital Costs Associated With Shunt Infections in Patients Receiving Antibiotic-Impregnated Shunt Catheters Versus Standard Shunt Catheters

Abstract: The introduction of AIS catheters in our institutional practice reduced the incidence of shunt infection and resulted in significant hospital cost savings. AIS systems are efficient and cost-effective instruments to prevent perioperative colonization of CSF shunt components.

Cited by 87 publications

References 37 publications

Reduction in CSF shunt infection over a 10-year period associated with the application of concentrated topical antibiotic powder directly to surgical wounds prior to closure

Reduction in CSF shunt infection over a 10-year period associated with the application of concentrated topical antibiotic powder directly to surgical wounds prior to closure

Transverse Sinus Stenting for Pseudotumor Cerebri: A Cost Comparison with CSF Shunting

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

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