Risk factors for infection and the effect of an institutional shunt protocol on the incidence of ventricular access device infections in preterm infants

Spader, Heather S.; Hertzler, Dean A.; Kestle, John R. W.; Riva-Cambrin, Jay

doi:10.3171/2014.9.peds14215

Cited by 46 publications

(20 citation statements)

References 9 publications

(10 reference statements)

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“…That younger patients are more vulnerable to implanted CNS hardware infections is not novel or surprising, and is consistent with many pediatric CSF shunt studies. 9,11 What is novel, however, is that the youngest group of children (less than 4 years of age) did not have the highest infection rate (8.6%) (Fig. 1).…”

Section: Patient Agementioning

confidence: 91%

Risk factors for baclofen pump infection in children: a multivariate analysis

Spader¹,

Bollo²,

Bowers³

et al. 2016

PED

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OBJECTIVE Intrathecal baclofen infusion systems to manage severe spasticity and dystonia are associated with higher infection rates in children than in adults. Factors unique to this population, such as poor nutrition and physical limitations for pump placement, have been hypothesized as the reasons for this disparity. The authors assessed potential risk factors for infection in a multivariate analysis. METHODS Patients who underwent implantation of a programmable pump and intrathecal catheter for baclofen infusion at a single center between January 1, 2000, and March 1, 2012, were identified in this retrospective cohort study. The primary end point was infection. Potential risk factors investigated included preoperative (i.e., demographics, body mass index [BMI], gastrostomy tube, tracheostomy, previous spinal fusion), intraoperative (i.e., surgeon, antibiotics, pump size, catheter location), and postoperative (i.e., wound dehiscence, CSF leak, and number of revisions) factors. Univariate analysis was performed, and a multivariate logistic regression model was created to identify independent risk factors for infection. RESULTS A total of 254 patients were evaluated. The overall infection rate was 9.8%. Univariate analysis identified young age, shorter height, lower weight, dehiscence, CSF leak, and number of revisions within 6 months of pump placement as significantly associated with infection. Multivariate analysis identified young age, dehiscence, and number of revisions as independent risk factors for infection. CONCLUSIONS Young age, wound dehiscence, and number of revisions were independent risk factors for infection in this pediatric cohort. A low BMI and the presence of either a gastrostomy or tracheostomy were not associated with infection and may not be contraindications for this procedure.

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Section: Patient Agementioning

confidence: 91%

Risk factors for baclofen pump infection in children: a multivariate analysis

Spader¹,

Bollo²,

Bowers³

et al. 2016

PED

Self Cite

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“…36 However, researchers at Johns Hopkins University recently published their institutional experience with posthemorrhagic hydrocephalus and reported a 47% male distribution. 38 A regional breakdown revealed that the South had 42% of IVH admissions (37% US population per US Census Bureau), whereas the Northeast, Midwest, and West proportions were slightly lower than their population percentiles (Fig.…”

Section: Population Trendsmentioning

confidence: 99%

Trends in hospitalization of preterm infants with intraventricular hemorrhage and hydrocephalus in the United States, 2000–2010

Christian

Jin

Attenello

et al. 2016

PED

121

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OBJECT Even with improved prenatal and neonatal care, intraventricular hemorrhage (IVH) occurs in approximately 25%–30% of preterm infants, with a subset of these patients developing hydrocephalus. This study was undertaken to describe current trends in hospitalization of preterm infants with posthemorrhagic hydrocephalus (PHH) using the Nationwide Inpatient Sample (NIS) and the Kids’ Inpatient Database (KID). METHODS The KID and NIS were combined to generate data for the years 2000–2010. All neonatal discharges with ICD-9-CM codes for preterm birth with IVH alone or with IVH and hydrocephalus were included. RESULTS There were 147,823 preterm neonates with IVH, and 9% of this group developed hydrocephalus during the same admission. Of patients with Grade 3 and 4 IVH, 25% and 28%, respectively, developed hydrocephalus in comparison with 1% and 4% of patients with Grade 1 and 2 IVH, respectively. Thirty-eight percent of patients with PHH had permanent ventricular shunts inserted. Mortality rates were 4%, 10%, 18%, and 40%, respectively, for Grade 1, 2, 3, and 4 IVH during initial hospitalization. Length of stay has been trending upward for both groups of IVH (49 days in 2000, 56 days in 2010) and PHH (59 days in 2000, 70 days in 2010). The average hospital cost per patient (adjusted for inflation) has also increased, from $201,578 to $353,554 (for IVH) and $260,077 to $495,697 (for PHH) over 11 years. CONCLUSIONS The number of neonates admitted with IVH has increased despite a decrease in the number of preterm births. Rates of hydrocephalus and mortality correlated closely with IVH grade. The incidence of hydrocephalus in preterm infants with IVH remained stable between 8% and 10%. Over an 11-year period, there was a progressive increase in hospital cost and length of stay for preterm neonates with IVH and PHH that may be explained by a concurrent increase in the proportion of patients with congenital cardiac anomalies.

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“…In a recent large retrospective series of ventricular access device infection in premature neonates; however, sepsis alone without meningitis was not found to be a risk factor for device infection. 30 Second, HIV-positive cases of cryptococcal meningitis generally have high titers of cryptococcal capsular polysaccharide due to massive fungal infestation with absent host immune response. 8,13 This high level of CSF polysaccharide may increase the risk of mechanical shunt obstruction, but has not been specifically reported in this population.…”

Section: Shunt Placement In the Immunocompromisedmentioning

confidence: 99%

Shunting in cryptococcal meningitis

Cherian¹,

Atmar

Gopinath³

2016

JNS

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obJective Patients with cryptococcal meningitis often develop symptomatic intracranial hypertension. The need for permanent CSF diversion in these cases remains unclear. Methods Cases of cryptococcal meningitis over a 5-year period were reviewed from a single, large teaching hospital. Sources of identification included ICD-9 codes, operative logs, and microscopy laboratory records. results Fifty cases of cryptococcal meningitis were identified. Ninety-eight percent (49/50) of patients were HIV positive. Opening pressure on initial lumbar puncture diagnosing cryptococcal meningitis was elevated (> 25 cm H 2 O) in 33 cases and normal (≤ 25 cm H 2 O) in 17 cases. Thirty-eight patients ultimately developed elevated opening pressure over a follow-up period ranging from weeks to years. Serial lumbar punctures for relief of intracranial hypertension were performed in 29 cases. Thirteen of these patients ultimately had shunting procedures performed after failing to improve clinically. Two factors were significantly associated with the need for shunting: patients undergoing shunt placement were more likely to be women (5/13 vs 0/16; p = 0.01) and to have a pattern of increasing CSF cryptococcal antigen (10/13 vs 3/16 cases; p = 0.003). All patients re-presenting with mycological relapse either underwent or were offered shunt placement. coNclusioNs Neurosurgeons are often asked to consider CSF diversion in cases of cryptococcal meningitis complicated by intracranial hypertension. Most patients do well with serial lumbar punctures combined with antifungal therapy. When required, shunting generally provided sustained relief from intracranial hypertension symptoms. Ventriculoperitoneal shunts are the favored method of diversion. To the authors' knowledge, the present study is the largest series on diversionary shunts in primarily HIV-positive patients with this problem.

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Risk factors for infection and the effect of an institutional shunt protocol on the incidence of ventricular access device infections in preterm infants

Cited by 46 publications

References 9 publications

Risk factors for baclofen pump infection in children: a multivariate analysis

Risk factors for baclofen pump infection in children: a multivariate analysis

Trends in hospitalization of preterm infants with intraventricular hemorrhage and hydrocephalus in the United States, 2000–2010

Shunting in cryptococcal meningitis

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