Incidence and Risk Factors of Ventriculoperitoneal Shunt Infections in Children: A Study of 333 Consecutive Shunts in 6 Years

Abstract

The major aims of this study were to estimate the infection rate and recognize the risk factor for ventriculoperitoneal (VP) shunt infections in children. To analyze shunt infection rate and identify risk factors, a retrospective cohort analysis of 333 consecutive VP shunt series was performed at Seoul National University Children's Hospital in Korea between January 2005 and February 2011. Overall, 35 shunts (10.5%) were infected, which represented an infection rate of 0.075 infection cases per shunt per year. VP shunt infection occurred at a median of 1 month (range, 6 days to 8 months) after insertion. An independent risk factor for shunt infection was undergoing an operation before the first year of life (relative risk 2.31; 95% confidence interval, 1.19-4.48). The most common causative microorganism was coagulase-negative staphylococci in 16 (45.7%) followed by Staphylococcus aureus in 8 (22.9%). Methicillin resistance rate was 83.3% among coagulase-negative staphylococci and S. aureus. In this study, cerebrospinal fluid shunt infection rate was 10.5%. Infection was frequently caused by methicillin-resistant coagulase-negative staphylococci and S. aureus within two months after shunt surgery. Vancomycin may be considered as the preoperative prophylaxis for shunt surgery in a situation where methicillin resistance rate is very high.

Characteristics and management of ventricular shunt infections in children, 2000-2015: a single centre retrospective chart review

“…Infants and children born prematurely are known to have a higher risk of shunt infection 9,10,14,16 . In our population 46% of the patients were born prematurely and 41% had the first infection before the age of one year.…”

“…In general, younger and premature children have a higher risk due to immaturity of their immune system and differences in skin flora compared to older children 15 . Premature infants who have had shunt surgery before 40 weeks gestational age have the greatest risk of all ages (Hazard radio (HR): 4.72, 95% CI 1.71-13.06) 9,10,14,16 . Children who have multiple shunt revision procedures, either because of shunt blockage, malfunction, fracture or infection are also at greater risk as with each revision, the cumulative risk rises 11 .…”

“…Recognition of shunt infections in children can be difficult as they present with a wide variety of non-specific symptoms such as fever, vomiting, drowsiness, headaches, irritability, seizures and abdominal pain 3,10,17 . Up to 90% of shunt infections occur within the first three to nine months after shunt insertion.…”

“…Rates of infection per shunt vary widely, between 3 and 13% 3,6,[8][9][10][11][12] . Overall shunt infection rate in the UK is estimated at 5.2% 7 .…”

“…Staphylococcus epidermidis is the most frequent coagulase-negative staphylococci (CoNS) 7,12 . Other common organisms are Staphylococcus aureus (5-26%) and other CoNS (36.1-53%) [9][10][11]17,19 . Gram-negative organisms are also frequent findings, accounting for up to 54% of infections in some series 20 .…”