Ventricular access device infection rate: a retrospective study and review of the literature

Abstract

Purpose Ventricular access devices (VAD) are often used for treatment of posthemorrhagic hydrocephalus (PHH) in preterm infants. The reported rates of infection have varied and range from 0 to 22 %. The objective of our study is to present our VAD associated infection at our institution. Methods The charts for patients that had VADs inserted between May 1, 2009 and October 31, 2013 at a single institution (Children's Healthcare of Atlanta) were retrospectively reviewed. The number of VAD infections, defined as either cerebrospinal fluid (CSF)-positive cultures or wound complication, was recorded. Of patients that survived, the number of VAD to shunt conversions was also examined. The data from 15 previously published studies were pooled to determine overall VAD infection and VAD to shunt conversion rates. Results A total of 142 VADs were placed. There were 13 infections (9.2 %), 11 of which had CSF-positive cultures (7.7 %). There were two wound complications with negative CSF cultures. Six patients died after VAD placement for reasons unrelated to their VAD surgeries (4.2 %). In the remaining patients, there were 113 VAD to shunt conversions (83.1 %). Fifteen studies that reported VAD infections were analyzed; an overall infection rate of 7.0 % and VAD to shunt conversion rate of 79 % were calculated. Conclusions While VAD is a valuable tool to treat PHH, it remains a procedure with an infection rate between 7.0 and 8.0 %. Close follow-up is needed to capture these adverse events as early as possible. Approximately 80 % of patients with PHH will require permanent CSF diversion.

Early endoscopic ventricular irrigation for the treatment of neonatal posthemorrhagic hydrocephalus. a feasible treatment option or not ? -a multi center report-

“…ranging from 0% to 50% (7,17,23). Moreover permanent shunt placement following external ventricular drainage treatment is still very common (6,15,23).…”

“…Shooman et al explained that ventricular access device is less traumatic than serial lumbar punctures and ventricular tapping and causes fewer problems than external ventricular drainage or subgaleal shunts (21). Regarding the initial treatment with ventricular access device technique, different series reported infection rates ranging between 6% and 10% (6,10,22). In cases where ventricular access device placement was preferred as the initial treatment for PHH, device revision rates were reported as high as 20%, and permanent CSF shunt requirement rates was reported up to 88% (4,6,10,22).…”

A Retrospective Study on the Avoidability of Ventriculoperitoneal Shunt Infections in a University Hospital in Al-Khobar, Saudi Arabia

“…As a comparison with other studies, VP shunting is associated with a higher number of infections than are other procedures because of the presence of a large number of normal flora in the peritoneum that can be pathogenic to other tissues of the body such as CSF [2][3]. However, VP shunting is the second most common approach used for the management of hydrocephalus at KFHU.…”

Risk factors associated with conversion of an Ommaya reservoir to a permanent cerebrospinal fluid shunt in preterm posthemorrhagic hydrocephalus

“…Consistent with other reports, there was a 100% shunt conversion rate in this group of patients. 8 In addition, the objective of this study was to analyze the biochemical parameters of CSF as predictors of permanent shunt implantation, and the nature of the infectious process inexorably alters these biochemical parameters.…”