Risk factors and epidemiology of pediatric ventriculoperitoneal shunt infection

Abstract

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.

Revision and complication rates in adult shunt surgery: a single-institution study

“…Regression analysis did not reveal that factors such as age, gender or aetiology to be independent risk factors for the occurrence of revision surgery due to infection, unlike other previous studies [ 17 ]. Other reports have also indicated that subsequent shunt revisions increase the risk of further shunt infections in paediatric patients [ 3 ]. Proximal failure and misplacement (either proximally or distally) came close as the second most common cause for primary revision.…”

Patterns and prognosis of Ventriculoperitoneal shunt malfunction among pediatrics in Saudi Arabia

“…V entriculoperitoneal )VP( shunt insertion is one of the most common procedures in pediatric neurosurgery for treating hydrocephalus. 1 Among pediatric age group hydrocephalus is considered a common, surgically correctable condition in which there is an increase in the volume cerebrospinal fluid )CSF(, leading to cerebral ventricles dilatation, thinning of the cerebral mantle, and elevation of intracranial pressure. 2 Patients with VP shunts represent more than 30,000 hospital admissions per year.…”

“…2 Although VP shunting has decreased the morbidity and mortality of hydrocephalus, it is still associated with multiple complications, many of which require surgical revision. [1][2][3][4] Recent studies have reported the rate of complications following VP shunting to be between 30% and 50%. [3][4][5][6] Shunt malfunctions causes can be categorized into infectious, mechanical, or functional.…”

“…3 Many important predictors of VP shunt failure have been reported in the literature, including etiologies of the hydrocephalus, prematurity, and age at the initial placement of the shunt. 1,8,9 Clinical factors that may increase the risk of shunt revision include time from the first surgery, surgical procedure duration, prior treatments, number of surgeons, surgical expertise, surgical technique, anatomic site of the shunt, and diagnosis. 1,[7][8][9][10] Proximal catheter tip location is another predictor, as tip positions in the Foramen of Monro, lateral ventricles, or the third ventricle all were associated with lower rates of surgical revision.…”

“…1,8,9 Clinical factors that may increase the risk of shunt revision include time from the first surgery, surgical procedure duration, prior treatments, number of surgeons, surgical expertise, surgical technique, anatomic site of the shunt, and diagnosis. 1,[7][8][9][10] Proximal catheter tip location is another predictor, as tip positions in the Foramen of Monro, lateral ventricles, or the third ventricle all were associated with lower rates of surgical revision. 11 Other predictors of shunt failure were reported to be poor catheter placement and use of a non-programmable valve.…”