Protective effect of rifampicin and clindamycin impregnated devices against Staphylococcusspp. infection after cerebrospinal fluid diversion procedures

Gutiérrez-González, Raquel; Boto, G.R.; Fernández-Pérez, Cristina; Prado, Náyade del

doi:10.1186/1471-2377-10-93

Cited by 28 publications

(16 citation statements)

References 36 publications

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“…Although 2 earlier studies did not find any effect on infection rates from AIS catheter use, 11,21 larger studies, including meta-analyses, have reported a reduction largely in line with that reported in the present study. 2,[7][8][9][10][12][13][14][15][16][17]20,22,24,28 This study supports previous recommendations made in favor of universal adoption of AISs. There is increasing evidence that, in addition to improvement in clinical outcome, there are strong economic and cost-effectiveness arguments for the use of AIS catheters.…”

Section: Discussionsupporting

confidence: 80%

“…2,[7][8][9][10][11][12][13][14][15][16][17][20][21][22]24,28 These studies are somewhat heterogeneous in terms of follow-up, patient population (pediatric only, adult only, or mixed), whether primary insertion only or revision surgeries also were included, and in reporting of causative pathogens. Some recent studies have highlighted the possibility of AIS catheters promoting selection of antibiotic-resistant organisms.…”

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confidence: 99%

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Effect of introduction of antibiotic-impregnated shunt catheters on cerebrospinal fluid shunt infection in children: a large single-center retrospective study

James¹,

Hartley

Morgan³

et al. 2014

PED

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Object Infection after both primary and revision shunt surgeries remains a major problem in pediatric neurosurgical practice. Antibiotic-impregnated shunt (AIS) tubing has been proposed to reduce infection rates. The authors report their experience with AIS catheters in their large pediatric neurosurgery department. Methods The authors conducted a retrospective case review of consecutive shunt operations performed before (1993–2003) and after (2005–2009) introduction of AIS tubing, with analysis of shunt infection rates and causative organisms identified. Results The historical control group consisted of 1592 consecutive shunt operations (657 primary insertions), and the AIS study group consisted of 500 consecutive shunt operations (184 primary insertions). Patients ranged in age from 0–17 years. In the historical group, 135 infections were identified (8.4%). In the AIS study group, 25 infections were identified (5%), representing a significant reduction (p < 0.005). The latency to diagnosis of infection was 23 days in the historical group and 139 days in the AIS study group. The infection rates in infants 0–6 months of age were 12.2% (historical group) and 6.7% (AIS group, p < 0.005), and in infants 7–12 months of age the rates were 7.9% (historical group) and 2.7% (AIS group, p < 0.005). In the historical control group, the frequency rank order of causative organisms was coagulase-negative staphylococcus (51.9%), Staphylococcus aureus (31.6%), streptococcus or enterococcus spp. (8.8%), gram-negative organisms (4.4%), and Propionibacterium acnes (2.2%). Organisms responsible for infections in AIS were S. aureus (40%), followed by streptococcus or enterococcus spp. (20%), P. acnes and coagulase-negative staphylococcus (both 16%), and gram-negative organisms (4%). No unusually antibiotic-resistant bacteria were identified in either group. The authors further subdivided the AIS group into those undergoing primary AIS insertion (Subgroup 1), those undergoing revision of non-AIS systems using AIS components (Subgroup 2), and those undergoing revision of AIS systems using AIS components (Subgroup 3). Infection rates were 1.6% in Subgroup 1, 2.5% in Subgroup 2, and 11.7% in Subgroup 3. Staphylococcus aureus was the most common organism identified in infections of the Subgroups 2 and 3. Conclusions Use of AIS tubing significantly improves shunt infection rates in both general pediatric and infant populations with no evidence of increased antibiotic resistance, which is in agreement with previous studies. However, the increased infection rate in revision surgery in children with AIS catheters in situ raises questions about their long-term application.

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Section: Discussionsupporting

confidence: 80%

mentioning

confidence: 99%

Effect of introduction of antibiotic-impregnated shunt catheters on cerebrospinal fluid shunt infection in children: a large single-center retrospective study

James¹,

Hartley

Morgan³

et al. 2014

PED

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“…Five studies were conducted in children and in adult populations. 16,21,22,24,25 A random model was used because of statistically high heterogeneity between studies (c 2 ¼ 10.45; P ¼ .03; I 2 ¼ 62%), and the value of RR was 0.31 with a significant benefit in favor of AI-EVD catheters (95% CI, 0.14-0.67; P ¼ .003) (Fig 5B). The pooled data from all 10 studies showed a significant difference (RR, 0.31; 95% CI, 0.18-0.55; P < .0001), but statistically significant moderate heterogeneity was observed between the studies (c 2 ¼ 18.09; P ¼ .03; I 2 ¼ 50%).…”

Section: Ai-evd Vs Plain Evd Cathetersmentioning

confidence: 99%

“…The characteristics of the included studies are summarized in Table 1 and Table 2. 16,[18][19][20][21][22][23][24][25][26][27][28][29][30] Ten studies compared AI-EVD catheters with plain EVD catheters, of which 3 were RCTs. Five studies compared SI-EVD catheters with plain EVD catheters, but only 1 study was an RCT.…”

Section: Study Characteristicsmentioning

confidence: 99%

Impact of antibiotic- and silver-impregnated external ventricular drains on the risk of infections: A systematic review and meta-analysis

Cui

Wang

Zhong

et al. 2015

American Journal of Infection Control

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“…4,6,37 Many studies have evaluated the efficacy of AISs compared with standard shunts (SSs) in the prevention of shunt infections, including two recent systematic reviews and meta-analyses. 1,2,15,17,[19][20][21]24,27,28,31,35,36,38,44,45,50,51,53 The purpose of this evidence-based review is to examine data on the use of AISs and SSs and compare these treatments in the prevention of shunt infections in the pediatric population.…”

mentioning

confidence: 99%

Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 7: Antibiotic-impregnated shunt systems versus conventional shunts in children: a systematic review and meta-analysis

Klimo

Thompson

Baird

et al. 2014

PED

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Object The objective of this systematic review and meta-analysis was to answer the following question: Are antibiotic-impregnated shunts (AISs) superior to standard shunts (SSs) at reducing the risk of shunt infection in pediatric patients with hydrocephalus? Methods Both 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 AIS use in children. Abstracts were reviewed, after which studies meeting the inclusion criteria were selected. An evidentiary table was assembled summarizing the studies and the quality of their 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 the chi-square and I2 statistics. Based on the quality of the literature and the result of the meta-analysis, a recommendation was rendered (Level I, II, or III). Results Six studies, all Class III, met our inclusion criteria. All but one study focused on a retrospective cohort and all but one were conducted at a single institution. Four of the studies failed to demonstrate a lowered infection rate with the use of an AIS. However, when the data from individual studies were pooled together, the infection rate in the AIS group was 5.5% compared with 8.6% in the SS group. Using a random-effects model, the cumulative RR was 0.51 (95% CI 0.29–0.89, p < 0.001), indicating that a shunt infection was 1.96 times more likely in patients who received an SS. Conclusions We recommend AIS tubing because of the associated lower risk of shunt infection compared to the use of conventional silicone hardware (quality of evidence: Class III; strength of recommendation: Level III). Recommendation: Antibiotic-impregnated shunt (AIS) tubing may be associated with a lower risk of shunt infection compared with conventional silicone hardware and thus is an option for children who require placement of a shunt. Strength of Recommendation: Level III, unclear degree of clinical certainty.

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Protective effect of rifampicin and clindamycin impregnated devices against Staphylococcusspp. infection after cerebrospinal fluid diversion procedures

Cited by 28 publications

References 36 publications

Effect of introduction of antibiotic-impregnated shunt catheters on cerebrospinal fluid shunt infection in children: a large single-center retrospective study

Effect of introduction of antibiotic-impregnated shunt catheters on cerebrospinal fluid shunt infection in children: a large single-center retrospective study

Impact of antibiotic- and silver-impregnated external ventricular drains on the risk of infections: A systematic review and meta-analysis

Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 7: Antibiotic-impregnated shunt systems versus conventional shunts in children: a systematic review and meta-analysis

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