Sonication Improves Pathogen Detection in Ventriculoperitoneal Shunt-Associated Infections

Neurosurgery ◽  
2018 ◽  
Vol 85 (4) ◽  
pp. 516-523 ◽  
Author(s):  
Vincent Prinz ◽  
Simon Bayerl ◽  
Nora Renz ◽  
Andrej Trampuz ◽  
Peter Vajkoczy ◽  
...  
Keyword(s):  
Pathogen Detection ◽  
Shunt Infection ◽  
Antimicrobial Treatment ◽  
Microbiological Analysis ◽  
Tissue Samples ◽  
Vp Shunt ◽  
Causative Microorganism ◽  
Microbiological Methods ◽  
Microbiological Examination ◽  
Shunt Infections

Abstract BACKGROUND Antimicrobial treatment of ventriculoperitoneal (VP) shunt infections is challenging when the causative pathogen is unknown. OBJECTIVE To evaluate the value of sonication of explanted shunt-devices to improve the microbiological detection rate. METHODS All consecutive patients undergoing revision surgery due to suspected VP-shunt infection from January 2015 to February 2017 were evaluated. Intraoperative tissue samples, wound swabs, and cerebrospinal fluid (CSF) were collected for microbiological examination. In a subgroup of patients, the removed implants were additionally sent for sonication. RESULTS A total of 35 patients were included with a mean age of 57.5 ± 18 yr, 21 were female (60%). In 13 patient's tissue samples, CSF and wound swabs were analyzed. In 22 patients, the explanted device was additionally sent for sonication. All 22 sonication cultures showed a positive microbiological result (100%), whereas with conventional microbiological methods, the causative microorganism was identified in 8 of 13 (61%; P = .018). Analyzed by method, all 22 sonication cultures (100%) were positive and 21 of 35 conventional microbiological analysis results (60%) detected the causative agent (P < .001.) In 18 patients (51%), antimicrobial treatment was started preoperatively. In those patients, the pathogen was detected in all 12 sonication cultures (100%), whereas conventional methods grew a pathogen in 3 of 6 patients (P = .005). CONCLUSION Sonication significantly increases the microbiological yield in VP-shunt infections, especially in patients receiving antibiotics prior to diagnostics and in infections caused by low-virulent organisms. The implementation of sonication into the clinical routine can substantially increase the rate of pathogen detection allowing targeted treatment.

Ventriculoperitoneal shunt infection rates using a standard surgical technique, including topical and intraventricular vancomycin: the Children’s Hospital Oakland experience

2020 ◽  
Vol 26 (5) ◽  
pp. 504-512
Author(s):  
Kunal P. Raygor ◽  
Taemin Oh ◽  
Joan Y. Hwang ◽  
Ryan R. L. Phelps ◽  
Kristen Ghoussaini ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Shunt Infection ◽  
Csf Leak ◽  
Causative Organism ◽  
Shunt Operation ◽  
Infection Prophylaxis ◽  
Infection Rates ◽  
Single Institution ◽  
Vp Shunt ◽  
Shunt Infections

OBJECTIVEVentriculoperitoneal (VP) shunt infections are common complications after shunt operations. Despite the use of intravenous antibiotics, the incidence of infections remains high. Though antibiotic-impregnated catheters (AICs) are commonly used, another method of infection prophylaxis is the use of intraventricular (IVT) antibiotics. The authors describe their single-institution experience with a standard shunt protocol utilizing prophylactic IVT and topical vancomycin administration and report the incidence of pediatric shunt infections.METHODSThree hundred two patients undergoing VP shunt procedures with IVT and topical vancomycin between 2006 and 2016 were included. Patients were excluded if their age at surgery was greater than 18 years. Shunt operations were performed at a single institution following a standard shunt protocol implementing IVT and topical vancomycin. No AICs were used. Clinical data were retrospectively collected from the electronic health records.RESULTSOver the 11-year study period, 593 VP shunt operations were performed with IVT and topical vancomycin, and a total of 19 infections occurred (incidence 3.2% per procedure). The majority of infections (n = 10, 52.6%) were caused by Staphylococcus epidermidis. The median time to shunt infection was 3.7 weeks. On multivariate analysis, the presence of a CSF leak (OR 31.5 [95% CI 8.8–112.6]) and age less than 6 months (OR 3.6 [95% CI 1.2–10.7]) were statistically significantly associated with the development of a shunt infection. A post hoc analysis comparing infection rates after procedures that adhered to the shunt protocol and those that did not administer IVT and topical vancomycin, plus historical controls, revealed a difference in infection rates (3.2% vs 6.9%, p = 0.03).CONCLUSIONSThe use of a standardized shunt operation technique that includes IVT and topical vancomycin is associated with a total shunt infection incidence of 3.2% per procedure, which compares favorably with the reported rates of shunt infection in the literature. The majority of infections occurred within 2 months of surgery and the most common causative organism was S. epidermidis. Young age (< 6 months) at the time of surgery and the presence of a postoperative CSF leak were statistically significantly associated with postoperative shunt infection on multivariate analysis. The results are hypothesis generating, and the authors propose that IVT and topical administration of vancomycin as part of a standardized shunt operation protocol may be an appropriate option for preventing pediatric shunt infections.

scholarly journals Shunt infection and malfunction in patients with myelomeningocele

2021 ◽  
pp. 1-7
Author(s):  
Michael D. White ◽  
Michael M. McDowell ◽  
Nitin Agarwal ◽  
Stephanie Greene
Keyword(s):  
Infection Rate ◽  
Revision Rate ◽  
Shunt Infection ◽  
Research Network ◽  
Shunt Insertion ◽  
Vp Shunt ◽  
Shunt Infection Rate ◽  
Shunt Removal ◽  
Shunt Infections

OBJECTIVEMyelomeningocele (MMC) is frequently complicated by symptomatic hydrocephalus, necessitating early permanent CSF diversion and revision surgeries. Shunt infections are a common cause of shunt malfunction. This study aims to characterize long-term shunt-related outcomes of patients undergoing MMC closure.METHODSA total of 170 patients undergoing MMC closure between the years of 1995 and 2017 were identified from a retrospective review of a prospectively populated surgical database at the Children’s Hospital of Pittsburgh. Patients who underwent MMC closure and required ventriculoperitoneal (VP) shunt insertion met criteria and were included in the primary study analysis. Analysis with a Fisher exact test was performed for categorical variables, and Mann-Whitney U-tests were utilized for numerical data.RESULTSOf the 158 total patients undergoing MMC closure and meeting inclusion criteria, 137 (87%) required VP shunt insertion. These 137 patients demonstrated a shunt revision rate of 21.1% per person-year and a shunt infection rate of 2.1% per person-year over a mean follow-up of 10.8 years. Patients had a mean of 3.4 ± 0.6 shunt surgeries prior to their first infection. Patients undergoing immediate shunt removal, external ventricular drain placement, or shunt replacement after clearing the infection had lower rates of subsequent infections than patients who initially were managed with shunt externalization (p < 0.001). Placement of a shunt at the time of MMC closure was not found to be a risk factor for infection. Of patients with initial shunt placement after the implementation of the Hydrocephalus Clinical Research Network protocol in 2011, the authors’ institution has had a shunt infection rate of 4.2% per person-year and a revision rate of 35.7% per person-year.CONCLUSIONSThis study describes long-term outcomes of shunted MMC patients and factors associated with shunt infections. Most patients underwent multiple revisions prior to the first shunt infection. Shunt externalization may be ineffective at clearing the infection and should be avoided in favor of early shunt removal and external ventricular drainage, followed by shunt replacement once infection is demonstrated to have cleared.

A simple method to reduce infection of ventriculoperitoneal shunts

2010 ◽  
Vol 5 (6) ◽  
pp. 569-572 ◽  
Author(s):  
Atiq-ur Rehman ◽  
Tausif-ur Rehman ◽  
Hassaan H. Bashir ◽  
Vikas Gupta
Keyword(s):  
Shunt Infection ◽  
Control Group ◽  
Simple Method ◽  
Vp Shunt ◽  
Shunt Placement ◽  
Shunt Catheter ◽  
Skin Flora ◽  
Group A ◽  
Group B ◽  
Shunt Infections

Object Postoperative shunt infection is the most common and feared complication of ventriculoperitoneal (VP) shunt placement for treatment of hydrocephalus. The rate of shunt infection is highest in the 1st postoperative month. The most common organisms responsible for shunt infection include coagulase-negative Staphylococcus and Staphylococcus aureus. This suggests a transfer of patient's skin flora via the surgeons' glove as a possible means of infection. The authors conducted a study to determine if the rate of postoperative shunt infections could be reduced simply by changing gloves before handling the shunt catheter. Methods A total of 111 neonates born with congenital hydrocephalus requiring a VP shunt were enrolled retrospectively and divided into 2 groups: a control group of 54 neonates treated with standard protocol VP shunt placement (Group A) and a treatment group of 57 neonates in whom, after initially double gloving, the outer pair of gloves was removed before handling the shunt catheter (Group B). Shunt infection rates were compared up to 6 months postoperatively. Results There was a statistically significant reduction of infection rate from 16.33% in Group A (control) to 3.77% in Group B (p = 0.0458). Conclusions The study shows that a changing of gloves before handling the shunt catheter may be a simple and cost-effective way to reduce the burden of postoperative shunt infections.

The Effectiveness of Antibiotic-Coated Ventriculoperitoneal Shunts for Prevention of Shunt Infections in Patients with Myelomeningocele

2021 ◽  
pp. 1-4
Author(s):  
Bilal Ertuğrul ◽  
Metin Kaplan ◽  
Ömer Batu Hergünsel ◽  
Bekir Akgün ◽  
Sait Öztürk ◽  
...  
Keyword(s):  
Protective Effect ◽  
Statistical Difference ◽  
Shunt Infection ◽  
Infection Rates ◽  
Ventriculoperitoneal Shunts ◽  
Significant Statistical Difference ◽  
Shunt Infections

<b><i>Purpose:</i></b> Hydrocephalus is a common comorbidity among the newborns, with myelomeningocele (MMC) and ventriculoperitoneal (VP) shunts being frequently used for the treatment of such patients. In this study, we aimed to compare the effectiveness of antibiotic-free and antibiotic-coated shunts to reduce the rate of shunt infection in patients with hydrocephalus and accompanying MMC. <b><i>Methods:</i></b> 116 patients with hydrocephalus and MMC who were treated with VP shunts were included in the study. Shunt infection rates among antibiotic-free and antibiotic-coated shunts were compared. <b><i>Results:</i></b> Of the 116 patients included in the study, 39 had antibiotic-coated shunts and 77 had antibiotic-free shunts. Shunt infection developed in 4 of the 39 cases treated with antibiotic-coated shunts and in 5 of the 77 cases treated with shunts without antibiotics. No significant statistical difference was found between antibiotic-coated and antibiotic-free VP shunts in terms of shunt infection (<i>p</i> = 0.450, <i>p</i> &#x3e; 0.05). <b><i>Conclusion:</i></b> In patients with MMC, using VP shunts containing antibiotics was found not to have a protective effect in preventing shunt infection. Whether the sac is intact or ruptured does not affect this result.

Management of complicated shunt infections: a clinical report

2008 ◽  
Vol 1 (3) ◽  
pp. 223-228 ◽  
Author(s):  
Hector E. James ◽  
John S. Bradley
Keyword(s):  
Antibiotic Therapy ◽  
Treatment Protocol ◽  
Shunt Infection ◽  
The Body ◽  
Clinical Report ◽  
Intravenous Antibiotic ◽  
Once Daily ◽  
Intravenous Antibiotic Therapy ◽  
Shunt Infections

Object The authors present their experience with a protocol for the treatment of patients with complicated shunt infections. Methods Complicated shunt infections are defined for the purpose of this protocol as multiple compartment hydrocephalus, multiple organism shunt infection, severe peritonitis, or infections in other sites of the body. The initial treatment protocol for these patients was 3 weeks of intravenous antibiotic therapy and 2 weeks of twice daily intraventricular/intrashunt antibiotic therapy. Cerebrospinal fluid (CSF) cultures were monitored during therapy and obtained again 48 hours after completion. The shunt was completely replaced. Additionally, follow-up cultures were obtained in all patients 3–6 months after therapy was completed. Results A cure of the infection was achieved in all patients as defined by negative cultures obtained at completion of antibiotic therapy and in follow-up studies. The follow-up period was 2–11 years (mean 4.4 ± 2.5 years). The treatment protocol was modified in the patients treated after 1991, and 18 patients were treated with this modified treatment regime. In these patients, intraventricular antibiotics were administered only once daily for 14 days, and the CSF was cultured 24 hours after antibiotic therapy had been stopped instead of after 48 hours. The results were similar to those obtained with the initial protocol. Conclusions Based on their prospective nonrandomized series, the authors believe that patients with complicated shunt infections can be successfully treated with 2 weeks of intraventricular antibiotic therapy administered once daily, concurrent with 3 weeks of intravenous antibiotic therapy. This protocol reduces length of treatment and hospital stay, and avoids recurrence of infection.

Prospective surveillance of complications in a pediatric neurosurgery unit

2010 ◽  
Vol 5 (6) ◽  
pp. 544-548 ◽  
Author(s):  
James M. Drake ◽  
Jay Riva-Cambrin ◽  
Andrew Jea ◽  
Kurtis Auguste ◽  
Mandeep Tamber ◽  
...  
Keyword(s):  
External Ventricular Drain ◽  
Pediatric Neurosurgery ◽  
Shunt Infection ◽  
Shunt Revision ◽  
Third Ventriculostomy ◽  
Neurosurgical Procedures ◽  
Csf Leakage ◽  
Second Procedure ◽  
Shunt Infections ◽  
Csf Leaks

Object Complications of specific pediatric neurosurgical procedures are well recognized. However, focused surveillance on a specific neurosurgical unit, for all procedures, may lead to better understanding of the most important complications, and allow targeted strategies for quality improvement. Methods The authors prospectively recorded the morbidity and mortality events at a large pediatric neurosurgical unit over a 2-year period. Morbidity was defined as any significant adverse outcome or death (for obstructive shunt failure, within 30 days). Multiple and unrelated complications in the same patient were recorded as separate events. Results There were 1082 surgical procedures performed during the evaluation period. One hundred seventy-seven complications (16.4%) occurred in 147 patients. By procedure, the most common complications occurred in vascular surgery (41.7%) and brain tumor surgery (27.9%). The most common complications were CSF leakage (31 cases), a new neurological deficit (27 cases), early shunt or endoscopic third ventriculostomy obstruction (27 cases), and shunt infection (24 cases). Meningitis occurred in 19 cases: in 58% of shunt infections, 13% of CSF leaks, and 10% of wound infections. Sixty-four percent of adverse events required a second procedure, most commonly an external ventricular drain placement or shunt revision. Conclusions Complications in pediatric neurosurgical procedures are common, result in significant morbidity, and more than half the time require a repeat surgical procedure. Targeted strategies to prevent common complications, such as shunt infections or CSF leaks, might significantly reduce this burden.

scholarly journals Effect of Antibacterial Agents on the Microbial Flora of Some Fruits and Vegetables.

2020 ◽  
pp. 299-304
Author(s):  
Omorodion Nnenna ◽  
Oriji Gift
Keyword(s):  
Fruits And Vegetables ◽  
Antimicrobial Agents ◽  
Reduction Rate ◽  
Total Coliform ◽  
Viable Count ◽  
Microbiological Analysis ◽  
Total Viable Count ◽  
Coliform Count ◽  
Microbiological Methods ◽  
Bacillus Spp

Six samples of fruits (apple, banana, mango, orange, pineapple and watermelon) and six samples of vegetables (cabbage, carrot, cucumber, lettuce, potato and tomato) were purchased from wokem market in Choba town PH, Rivers State and microbiological analysis were carried out these fruits and vegetables samples and the effects of the antimicrobial agents (Ethanol and Hydrogen peroxide) on the microbial load. The Total viable count, Total coliform count and Escherichia count were determined via standard microbiological methods. The Total viable count ranged from 4.1x10106 to 1.0x107 cfu/g Total coliform count from 4.5x107 to 1.5x106 cfu/g nd the E.coli count ranged from 5.1x102 to 1.0x102 cfu/g. The Total viable count for apple ranged between to 5.1 x107 to 2.07x109 , Cabbage 1.45x109 to 4.9x107 , banana 1.10x109 to 5.9x107 , cucumber 1.82x108 to 6.0x107. The microorganisms isolated were Escherichia coli 42%, Staphylococcus aureus 30%, Pseudomonas spp 18%, Bacillus spp,6% and Serratia spp, 2%. Hydrogen perioxide had a high pathogen reduction rate than ethanol.The isolation of E coli and other pathogenic microorganisms indicates the presences of faecal contamination and the poor hygienic production, storage and transport system. Fruits and vegetables should be properly handled from their seeds planted in the farm to the matured ones sold in the market

scholarly journals Ventriculo-Peritoneal Shunt Infections in a Tertiary Center, 3 Years Experience

2021 ◽  
Author(s):  
Emre Dinçer ◽  
Nazan Dalgıç Karabulut
Keyword(s):  
Shunt Infection ◽  
Shunt Revision ◽  
Common Symptom ◽  
Skin Flora ◽  
Tertiary Center ◽  
Significant Difference ◽  
Common Etiology ◽  
Prolonged Hospital ◽  
Ventriculo Peritoneal Shunt ◽  
Shunt Infections

INTRODUCTION: Ventriculo-peritoneal shunt infection is the most important complication of shunt applications. In pediatric age, shunt infections are associated with shunt dysfunction, requirement for shunt revision, neurodevelopmental delay, prolonged hospital stay, and high treatment costs. In this study, we aimed to evaluate the characteristics of shunt infections of our patients and to compare the differences between early and late infections, infections caused by staphylococci and other strains and infection that did and did not recur. METHODS: In this retrospective study, shunt infections treated in the Pediatric Infection Clinic of Hamidiye Etfal Training and Research Hospital between July 2008 and July 2011 were evaluated. RESULTS: Forty-seven shunt infections in 42 patients were evaluated. Congenital anomalies were the most common etiology of hydrocephalus and fever was the most common symptom of the patients. Higher rates of early shunt infections, shunt infections in early childhood and infections caused by staphylococci species were observed. Patients with infections caused by staphylococci species received shorter duration of antibiotherapy (p=0.024). Infections that recurred in the six months of follow-up had higher rates of positive blood cultures (p=0.022). There was no statistically significant difference between early and late-term shunt infections. DISCUSSION AND CONCLUSION: Shunt infections were evaluated in different aspects in our study. Direct colonization of the shunt catheter still seems to be most important cause for the shunt infections because early infections and infections caused by skin flora were more common in our patient group.

Multidisciplinary approach to cerebrospinal fluid shunt infection with an appeal for attention to details in assessment and standardization in reporting

2011 ◽  
Vol 7 (5) ◽  
pp. 452-461 ◽  
Author(s):  
Ken R. Winston ◽  
Susan A. Dolan
Keyword(s):  
At Risk ◽  
Multidisciplinary Approach ◽  
Shunt Infection ◽  
Csf Shunt ◽  
Accurate Identification ◽  
Meaningful Information ◽  
Valid Data ◽  
Csf Shunt Infection ◽  
Criteria For Diagnosis ◽  
Shunt Infections

Object The goal of this study was to evaluate the problems encountered in monitoring CSF shunt infection, including the collection, analysis, and reporting of data. The authors propose a system that would produce more accurate, and hence more meaningful, information on shunt infection than do the methodologies and customs now in common use. Methods The authors reviewed and analyzed 19 years of quarterly records of a committee that has addressed CSF shunt infection in an ongoing manner. Results There are strong incentives, political and otherwise, to identify low rates of CSF shunt infection. Details of the composition and operation of a multidisciplinary approach to CSF shunt infection are summarized. Many factors affect the occurrence of shunt infection and its accurate assessment and reporting. Easily accessible sources for the identification of cases of shunt infections and for the assessment of an at-risk population often contain discrepancies in significant numbers. Conclusions Multidisciplinary oversight of the entire matter of CSF shunt infection enhances the chances for collecting accurate data, identifying causes of infection, and developing effective preventative strategies. Valid data require a mechanism for finding all individuals within the at-risk pool; the accurate identification of patients who had shunt infections; standard, pragmatic, and robust criteria for diagnosis of shunt infection; and multidisciplinary oversight of the entire process.

Microbiological quality and safety of Ready- to- eat foods from restaurants and food establishments in Yirgalem town Southern, Ethiopia

2019 ◽  
Author(s):  
Tsegaye Shamebo Arficho ◽  
Asefa Hamato Kebede
Keyword(s):  
Bacterial Load ◽  
Microbiological Quality ◽  
Food Samples ◽  
Coliform Bacteria ◽  
Plate Count ◽  
Southern Ethiopia ◽  
Microbiological Analysis ◽  
Quality And Safety ◽  
Mannitol Salt Agar ◽  
Microbiological Methods

Abstract Background: Foodborne illnesses are considered as one of the most important public health problems particularly in developing countries like Ethiopia. This study aimed to determine the microbiological quality and safety of ready-to-eat foods in Yirgalem town, southern Ethiopia from November 2016 to August 2017. Methods: The collection of ready-to-eat food samples and laboratory-based microbiological analysis was used as the study design. A total of 160 food samples comprising of 40 ‘Injera firfir’, 40‘Bayeaynet’, 40 Vegetables and 40 Spaghetti were collected and analyzed for microbial contamination following standard microbiological methods. Ten grams of each food sample was transferred into 90 ml of buffered peptone water and homogenized for 5 minutes using a vortex mixer. The homogenates were serial diluted up to 10-7 and a volume of 0.1ml aliquot was spread plated on pre-solidified media of Aerobic plate count agar, MacConkey agar, Mannitol salt agar, and Salmonella-Shigella agar and incubate at 35-37oc for 24 hrs. Also, Potato Dextrose Agar was used for the isolation of fungi. Data were entered into Microsoft Excel and analyzed using SPSS version 20.0. Results: All the collected food samples were subjected to total aerobic mesophilic bacteria, Coliform bacteria, Enterobacteriaceae, Staphylococcal, Yeasts, and Molds counts. Accordingly, the mean counts expressed as log10 CFU/g of food for each group of the organism were 7.90 ± 0.71, 4.31±1.30, 4.32 ± 1.30, 6.70 ± 0.34 and 4.5 ± 1.01, respectively. The highest bacterial load 162(28.9%) was detected in ‘Injera firfir’ whereas the lowest 108(19.2%) case was investigated in Spaghettis. Regarding the food safety issue, the frequency of S. aureus, E. coli and Salmonella spp in the food samples were 54.4%, 43.8%, and 0.6%, respectively. Conclusion: The high microbial load and existence of foodborne pathogens in ready-to-eat foods in Yirgalem town, Southern Ethiopia is calling for the creation of awareness among restaurant and food establishment owners and food handlers concerning the hygienic practice. Keyword: Microbial quality, Yirgalem town, Southern Ethiopia

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