Shunt Infection

Purpose: 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. Methods: 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. Results: 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 (p = 0.450, p > 0.05). Conclusion: 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.

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Evaluation of Microbial Bacterial and Fungal Diversity in Cerebrospinal Fluid Shunt Infection

PLoS ONE ◽

10.1371/journal.pone.0083229 ◽

2014 ◽

Vol 9 (1) ◽

pp. e83229 ◽

Cited By ~ 11

Author(s):

Tamara D. Simon ◽

Christopher E. Pope ◽

Samuel R. Browd ◽

Jeffrey G. Ojemann ◽

Jay Riva-Cambrin ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Fungal Diversity ◽

Shunt Infection ◽

Cerebrospinal Fluid Shunt

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A no-touch technique protocol to diminish cerebrospinal fluid shunt infection

Surgical Neurology ◽

10.1016/0090-3019(95)80060-t ◽

1995 ◽

Vol 43 (4) ◽

pp. 344-350 ◽

Cited By ~ 50

Author(s):

Walter J Faillace

Keyword(s):

Cerebrospinal Fluid ◽

Shunt Infection ◽

Cerebrospinal Fluid Shunt

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Candida albicans Shunt Infection: Report of Two Cases

Neurosurgery ◽

10.1227/00006123-198607000-00018 ◽

1986 ◽

Vol 19 (1) ◽

pp. 111-113 ◽

Cited By ~ 9

Author(s):

David J. Gower ◽

Kerry Crone ◽

Eben Alexander ◽

David L. Kelly

Keyword(s):

Candida Albicans ◽

Blood Cells ◽

White Blood Cells ◽

Shunt Infection ◽

Cerebrospinal Fluid Shunts ◽

Previous Therapy ◽

Relationship Of ◽

The Relationship ◽

Overall Mortality

Abstract Infection of cerebrospinal fluid shunts with Candida albicans is reported in two patients. Scanning electron microscopy in one case demonstrates the relationship of the Candida hyphae to the white blood cells and to silicone plastic. A review of 10 previously reported cases of Candida shunt infection indicates that the infection usually follows a major bacterial infection or direct contamination or occurs spontaneously, Previous therapy has usually involved removal of the shunt, and the role of parenteral antifungal therapy is still unclear. Overall mortality to date is 25%.

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Management of complicated shunt infections: a clinical report

Journal of Neurosurgery Pediatrics ◽

10.3171/ped/2008/1/3/223 ◽

2008 ◽

Vol 1 (3) ◽

pp. 223-228 ◽

Cited By ~ 11

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.

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A study on Complications of ventriculoperitoneal shunt surgery in Bir Hospital, Kathmandu, Nepal

Nepal Journal of Medical Sciences ◽

10.3126/njms.v1i2.6612 ◽

2012 ◽

Vol 1 (2) ◽

pp. 119-122 ◽

Cited By ~ 1

Author(s):

BG Karmacharya ◽

P Kumar

Keyword(s):

Ventriculoperitoneal Shunt ◽

Shunt Infection ◽

Shunt Surgery ◽

Inclusion Criteria ◽

Medical Sciences ◽

Referral Centre ◽

Neurosurgical Procedure ◽

Ventriculoperitoneal Shunts ◽

Shunt Procedure ◽

A Prospective Study

Background: Ventriculoperitoneal shunt is one of the most commonly performed neurosurgical procedure, both on the elective and emergency basis. However this procedure is dreaded because of complications. There is lack of prospective studies on complications of shunt procedure. In this study, the indications for shunt, the types used and complications of ventriculoperitoneal shunts were studied. Methods: This was a prospective study carried out in the national neurosurgical referral centre, Bir hospital, Kathmandu from April 2004 to March 2005. Results: There were 109 ventriculoperitoneal shunt procedures during the study period. Among them 60 consecutive patients who fulfilled the inclusion criteria were enrolled for the study. There were 43 male and 17 female patients, with age ranging from 4 months to 75 years. Fourteen patients (23.3%) developed complications which included shunt block, shunt infection, over drainage and shunt extrusion. Conclusion: About one fourth all patients who underwent ventriculoperitoneal shunt surgery developed complications. Shunt block and infections were the major complications. DOI: http://dx.doi.org/10.3126/njms.v1i2.6612 Nepal Journal of Medical Sciences. 2012;1(2): 119-22

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Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 6: Preoperative antibiotics for shunt surgery in children with hydrocephalus: a systematic review and meta-analysis

Journal of Neurosurgery Pediatrics ◽

10.3171/2014.7.peds14326 ◽

2014 ◽

Vol 14 (Supplement_1) ◽

pp. 44-52 ◽

Cited By ~ 32

Author(s):

Paul Klimo ◽

Mark Van Poppel ◽

Clinton J. Thompson ◽

Lissa C. Baird ◽

Ann-Christine Duhaime ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Class Ii ◽

Shunt Infection ◽

Shunt Surgery ◽

Level Ii ◽

Intravenous Antibiotics ◽

Preoperative Antibiotics ◽

Antibiotic Agents

Object The objective of this systematic review and meta-analysis was twofold: to answer the question “What is the evidence for the effectiveness of prophylactic intravenous antibiotics for infection prevention in shunt surgery?” and to make treatment recommendations based on the available evidence. Methods The US National Library of Medicine PubMed/MEDLINE database and the Cochrane Database of Systematic Reviews were queried using MeSH headings and key words relevant to prophylactic antibiotic use in children undergoing a shunt operation. Abstracts were reviewed to identify which studies met the inclusion criteria. An evidentiary table was assembled summarizing the studies and the quality of evidence (Classes I-III). A meta-analysis was conducted using a random-effects model to calculate a cumulative estimate of treatment effect using risk ratio (RR). Heterogeneity was assessed using chi-square and I2 statistics. A sensitivity analysis was also conducted. Based on the quality of the literature and the result of the meta-analysis, a recommendation was rendered (Level I, II, or III). Results Nine studies (4 Class I, 3 Class II, and 2 Class III) met our inclusion criteria. Of 7 randomized controlled trials (RCTs), 3 were downgraded from Class I to Class II because of significant quality issues, and all RCTs were potentially underpowered. In only 2 Class in retrospective cohort studies were preoperative antibiotic agents found to be protective against shunt infection. When data from the individual studies were pooled together, the infection rate in the prophylactic antibiotics group was 5.9% compared with 10.7% in the control group. Using a random-effects model, the cumulative RR was 0.55 (95% CI 0.38–0.81), indicating a protective benefit of prophylactic preoperative intravenous antibiotics. A sensitivity analysis of RCTs only (n = 7) also demonstrated a statistical benefit, but an analysis of higher-quality RCTs only (n = 4) did not. Conclusions Within the limits of this systematic review and meta-analysis, administration of preoperative antibiotic agents for shunt surgery in children was found to lower the infection risk (quality of evidence: Class II; strength of recommendation, Level II). Recommendation The use of preoperative antibiotic agents can be recommended to prevent shunt infection in patients with hydrocephalus. It was only by combining the results of the various underpowered studies (meta-analysis) that the use of preoperative antibiotics for shunt surgery in children was shown to lower the risk of shunt infection. Strength of Recommendation: Level II, moderate degree of clinical certainty.

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