scholarly journals S2962 “The Misty Mesentery”: Possible Sclerosing Mesenteritis Secondary to Previous VP Shunt Infections

2021 ◽  
Vol 116 (1) ◽  
pp. S1226-S1226
Author(s):  
Jeremy Van ◽  
Rana Abraham
Keyword(s):  
Sclerosing Mesenteritis ◽  
Vp Shunt ◽  
Shunt Infections

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.

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.

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.

Führt eine PEG-Implantation bei Säuglingen mit VP-Shunt zu einem ehöhten Meningitis-Risiko?

2006 ◽  
Vol 210 (S 5) ◽  
Author(s):  
S Sponholz ◽  
J Dinger ◽  
R Bergert ◽  
M Laaß ◽  
U Winkler
Keyword(s):  
Vp Shunt

Führt eine PEG-Implantation bei Säuglingen mit VP-Shunt zu einem ehöhten Meningitis-Risiko?

2006 ◽  
Vol 210 (S 5) ◽  
Author(s):  
S Sponholz ◽  
J Dinger ◽  
R Bergert ◽  
M Laaß ◽  
U Winkler
Keyword(s):  
Vp Shunt

Four Cases of Postoperative Sclerosing Mesenteritis

2007 ◽  
Vol 23 (5) ◽  
pp. 374 ◽  
Author(s):  
Eu Gene Kim ◽  
Yong Won Kang ◽  
Seo Gu Yoon ◽  
Heung Dai Kim ◽  
Kwang Yun Kim
Keyword(s):  
Sclerosing Mesenteritis

Colchicine as an Alternative First-Line Treatment of Sclerosing Mesenteritis: A Retrospective Study

2021 ◽  
Author(s):  
Pedro Cortés ◽  
Hassan M. Ghoz ◽  
Obaie Mzaik ◽  
Muhamad Alhaj Moustafa ◽  
Yan Bi ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Sclerosing Mesenteritis ◽  
Line Treatment ◽  
First Line ◽  
First Line Treatment

scholarly journals 332 The diagnostic role of shunt series radiographs (SSR) in children presenting to the children’s emergency department (CED) with suspected ventriculoperitoneal (VP) shunt failure

2020 ◽  
Vol 37 (12) ◽  
pp. 852.3-853
Author(s):  
Angharad Griffiths ◽  
Ikechukwu Okafor ◽  
Thomas Beattie
Keyword(s):  
Clinical Outcome ◽  
Sensitivity And Specificity ◽  
Clinical Information ◽  
Flow Diagram ◽  
List Type ◽  
Shunt Failure ◽  
Vp Shunt ◽  
Wide Range ◽  
Diagnostic Role

Aims/Objectives/BackgroundVP shunts are used to drain CSF from the cranial vault because of a wide range of pathologies and, like any piece of hardware, can fail. Traditionally investigations include SSR and CT. This project examines the role of SSR in evaluating children with suspected VP shunt failure.Primary outcome: Sensitivity and specificity of SSR in children presenting to the CED with concern for shunt failure.Methods/DesignConducted in a single centre, tertiary CED of the national Irish Neurosurgical(NS) referral centre (ED attendance:>50,000 patients/year). 100 sequential SSR requested by the CED were reviewed. Clinical information was extracted from electronic requests. Shunt failure was defined by the need for NS intervention(Revision).Abstract 332 Figure 1Abstract 332 Figure 2Results/ConclusionsSensitivity and specificity is presented in figure 1 (two by two table).100 radiographs performed in 84 children.22% shunts revised (see flow diagram).7 SSR’s were abnormal.85% (n=6) shunts revised. [5 following abnormal CT].Of the normal SSR’s; 16 had abnormal CT and revised.85/100 received CT.64 of 85 CT’s (75%) were normal.□6 of the 64 had focal shunt concern.SSR’s shouldn’t be used in isolation. NPV&PPV, Sensitivity&Specificity is low.SSR’s are beneficial where there’s concern over focal shunt problems (injury/pain/swelling) or following abnormal CT.VP shunt failure is not well investigated with SSR alone.SSR’s could be omitted where there is no focal shunt concern/after normal CT (without impacting clinical outcome) reducing radiation exposure and reduce impact on CED’s.59 SSR’s could have been avoided without adverse clinical outcome.

Sign in / Sign up

Export Citation Format

Share Document