Factors contributing to the medical costs of cerebrospinal fluid shunt infection treatment in pediatric patients with standard shunt components compared with those in patients with antibiotic-impregnated components

2007 ◽  
Vol 22 (4) ◽  
pp. 1-4 ◽  
Author(s):  
Daniel M. Sciubba ◽  
Li-Mei Lin ◽  
Graeme F. Woodworth ◽  
Matthew J. McGirt ◽  
Benjamin Carson ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Medical Costs ◽  
Shunt Infection ◽  
Csf Shunt ◽  
Shunt Insertion ◽  
Average Hospital ◽  
Infection Treatment ◽  
Shunt Infections

Object Antibiotic-impregnated shunt (AIS) systems may decrease the incidence of cerebrospinal fluid (CSF) shunt infections. However, there is a reluctance to use AIS components because of their increased cost. In the present study the authors evaluated factors contributing to the medical costs associated with the treatment of CSF shunt infections in a hydrocephalic pediatric population, those implanted with AIS systems compared with those implanted with standard shunt systems. Methods The authors retrospectively reviewed data obtained in all pediatric patients who had undergone CSF shunt insertion at their institution over a 3-year period. All patients were followed up for 12 months after surgery. The independent association between AIS catheter use and subsequent shunt infection was assessed by performing a multivariate proportional hazards regression analysis. Factors contributing to the medical costs associated with shunt infection were evaluated. Results Two hundred eleven pediatric patients underwent 353 shunting procedures. Two hundred eight shunts (59%) were placed with nonimpregnated catheters and 145 shunts (41%) were placed with AIS catheters. Twenty-five patients (12%) with non-AIS catheters experienced shunt infection, whereas only two patients (1.4%) with AIS catheters had a shunt infection within the 6-month follow-up period (p < 0.01). Among infected patients, infected patients with standard shunt components had a longer average hospital stay, more inpatient complications related to infection treatment, and more multiple organism infections and multiple antibiotic regimens, compared with those with AIS components. Conclusions Although individual AIS components are more expensive than standard ones, factors contributing to medical costs are fewer in pediatric patients with infected shunts when the components are antibiotic-impregnated rather than standard.

scholarly journals Intraventricular Vancomycin In Pediatric Patients With Cerebrospinal Fluid Shunt Infections

2004 ◽  
Vol 9 (1) ◽  
pp. 36-42 ◽  
Author(s):  
Majed Al-Jeraisy ◽  
Stephanie J. Phelps ◽  
Michael L. Christensen ◽  
Stephanie Einhaus
Keyword(s):  
Cerebrospinal Fluid ◽  
Pediatric Patients ◽  
Shunt Infection ◽  
Csf Shunt ◽  
Older Children ◽  
Vancomycin Concentration ◽  
Patients Âgés ◽  
Vancomycin Trough ◽  
Serum Vancomycin ◽  
Shunt Infections

OBJECTIVES To determine: 1) the range and magnitude of vancomycin trough cerebrospinal fluid (CSF) concentrations following intraventricular (IVT) vancomycin; 2) any correlation between patient demographic and CSF vancomycin concentrations; and 3) eradication and complications rates following IVT vancomycin. METHODS Medical records of pediatric patients with shunt infection who received IVT vancomycin during a 12 month period were reviewed. Demographic, microbiological data, IVT/intravenous (IV) vancomycin dosing, concomitant antibiotics, CSF and serum vancomycin concentrations, and CSF drainage output were recorded. RESULTS Seventeen patients ages 4 months to 17 years were hospitalized for shunt infection. Staphylococcus epidermidis (n=12) was the predominant organism. Sixteen patients received 10 mg, and one patient received 5 mg of IVT vancomycin for 3–23 days. All but one received concurrent IV vancomycin. The mean maximum trough CSF vancomycin concentration noted for 16 patients who recieved 10 mg of IVT vancomycin was 18.4±21.8 μg/mL (range: between 0.4 to 187.3 μg/mL). All four adolescents ≥25 kg had CSF vancomycin concentrations ≤5 μg/mL, three of four infants/children between 10.1 and 24.9 kg had trough CSF vancomycin concentrations between 10–20 μg/mL, and five of nine infants &lt;10 kg had CSF concentrations &gt;20 μg/mL. All organisms were successfully eradicated. One patient developed chronic eosinophilia presumed related to elevated CSF vancomycin concentrations (187 μg/mL). CONCLUSIONS –The combination of IVT and IV vancomycin effectively eradicated CSF shunt infections. CSF vancomycin concentrations are highly variable and poorly correlated with age and CSF output. Following a 10 mg IVT vancomycin dose, CSF concentrations appear to be lower in older children and elevated in infants/young children. One infant experienced a complication related to an elevated CSF vancomycin concentration; hence, therapy must be individualized, using CSF trough vancomycin concentrations.

scholarly journals Patient and Treatment Characteristics by Infecting Organism in Cerebrospinal Fluid Shunt Infection

2018 ◽  
Vol 8 (3) ◽  
pp. 235-243 ◽  
Author(s):  
Tamara D Simon ◽  
Matthew P Kronman ◽  
Kathryn B Whitlock ◽  
Samuel R Browd ◽  
Richard Holubkov ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Shunt Infection ◽  
Research Network ◽  
Csf Shunt ◽  
Coagulase Negative Staphylococcus ◽  
Gram Negative ◽  
Treatment Characteristics ◽  
Infection Treatment ◽  
Csf Shunt Infection ◽  
Univariate Analyses

Abstract Background Previous studies of cerebrospinal fluid (CSF) shunt infection treatment have been limited in size and unable to compare patient and treatment characteristics by infecting organism. Our objective was to describe variation in patient and treatment characteristics for children with first CSF shunt infection, stratified by infecting organism subgroups outlined in the 2017 Infectious Disease Society of America’s (IDSA) guidelines. Methods We studied a prospective cohort of children <18 years of age undergoing treatment for first CSF shunt infection at one of 7 Hydrocephalus Clinical Research Network hospitals from April 2008 to December 2012. Differences between infecting organism subgroups were described using univariate analyses and Fisher’s exact tests. Results There were 145 children whose infections were diagnosed by CSF culture and addressed by IDSA guidelines, including 47 with Staphylococcus aureus, 52 with coagulase-negative Staphylococcus, 37 with Gram-negative bacilli, and 9 with Propionibacterium acnes. No differences in many patient and treatment characteristics were seen between infecting organism subgroups, including age at initial shunt, gender, race, insurance, indication for shunt, gastrostomy, tracheostomy, ultrasound, and/or endoscope use at all surgeries before infection, or numbers of revisions before infection. A larger proportion of infections were caused by Gram-negative bacilli when antibiotic-impregnated catheters were used at initial shunt placement (12 of 23, 52%) and/or subsequent revisions (11 of 23, 48%) compared with all other infections (9 of 68 [13%] and 13 of 68 [19%], respectively). No differences in reinfection were observed between infecting organism subgroups. Conclusions The organism profile encountered at infection differs when antibiotic-impregnated catheters are used, with a higher proportion of Gram-negative bacilli. This warrants further investigation given increasing adoption of antibiotic-impregnated catheters.

Detailed standardized protocol to prevent cerebrospinal fluid shunt infection

2020 ◽  
Vol 132 (3) ◽  
pp. 755-759
Author(s):  
Yuma Okamura ◽  
Keisuke Maruyama ◽  
Shin Fukuda ◽  
Hiroshi Horikawa ◽  
Nobuyoshi Sasaki ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Postoperative Infection ◽  
Shunt Infection ◽  
Csf Shunt ◽  
Patient Age ◽  
Protocol Implementation ◽  
Patient Âgé ◽  
Significant Difference ◽  
Before And After ◽  
Shunt Infections

OBJECTIVEWhile cerebrospinal fluid (CSF) shunt surgery plays an essential role in the treatment of hydrocephalus, postoperative infection due to the implantation of foreign materials is still one of the most common and potentially serious complications of this procedure. Because no previously reported protocol has been proven to prevent postoperative infection after CSF shunt surgeries in adults, the authors investigated the effectiveness of a protocol introduced in their institution.METHODSA detailed standardized surgical protocol to prevent infection in patients undergoing CSF shunt surgeries was introduced in the authors’ institution in December 2011. The protocol included a series of detailed rules regarding the surgical procedure, the surgical environment to minimize contamination from air, double gloving, local injection of antibiotics, and postoperative management. The rate of CSF shunt infection during the 3 years after surgery before and after implementation of the protocol was compared in patients undergoing their first CSF shunt surgeries. The inclusion periods were from January 2006 to November 2011 for the preprotocol group and from December 2011 to December 2014 for the postprotocol group.RESULTSThe study included 124 preprotocol patients and 52 postprotocol patients. The mean patient age was 59 years in both groups, ranging from 40 days to 88 years. Comparison of patient background factors, including known risk factors for surgical site infections, showed no significant difference between the patient groups before and after implementation of the protocol. While 9 patients (7.3%) developed shunt infections before protocol implementation, no shunt infections (0%) were observed in patients who underwent surgery after protocol implementation. The difference was statistically significant (p = 0.047).CONCLUSIONSThe authors’ detailed protocol for CSF shunt surgeries was effective in preventing postoperative infection regardless of patient age.

The association between dental health and procedures and developing shunt infections in pediatric patients

2014 ◽  
Vol 14 (5) ◽  
pp. 508-513 ◽  
Author(s):  
Alan A. Moazzam ◽  
Ernest Nehrer ◽  
Stephanie L. Da Silva ◽  
José C. Polido ◽  
Anush Arakelyan ◽  
...  
Keyword(s):  
Bacterial Infections ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Dental Health ◽  
Shunt Infection ◽  
Dental Procedure ◽  
Gingival Health ◽  
Dental Procedures ◽  
Dental Records ◽  
Shunt Infections

Object Cerebrospinal fluid–diverting shunts are often complicated by bacterial infections. Dental procedures are known to cause transient bacteremia that could potentially spread hematogenously to these implanted devices. No literature currently exists to inform practitioners as to the need for prophylactic antibiotics for patients who possess these implants. The authors performed a retrospective study to assess whether dental procedures and poor oral health were associated with a higher likelihood of developing CSF-diverting shunt infections. Methods Neurosurgical and pediatric dental records from January 2007 to December 2012 were reviewed for shunt surgeries and dental encounters. Indications for shunt surgery and infection rates were recorded. Dental records were reviewed for several markers of overall dental health, such as a DMFT (decayed, missing, and filled teeth) score and a gingival health/oral hygiene score. The association between these scores and the incidence of shunt infections were studied. Moreover, the relationship between the incidence of shunt infections and the timing and invasiveness of preceding dental encounters were analyzed. Results A total of 100 pediatric patients were included in our study, for a total of 204 shunt surgeries. Twenty-one shunt infections were noted during the 6-year study period. Five of these shunts infections occurred within 3 months of a dental procedure. The odds ratio (OR) of developing a shunt infection within 3 months of a dental procedure was 0.98 (95% confidence interval [CI] 0.27–3.01), and was not statistically significant. The OR of developing a shunt infection after a high-risk dental procedure compared with a low-risk dental procedure was 1.32 (95% CI 0.02–16.29), and was not statistically significant. There was no significant association between measures of dental health, such as DMFT and gingival health score, and the likelihood of developing a shunt infection. The ORs for these 2 scores were 0.51 (95% CI 0.04–4.96) and 1.58 (95% CI 0.03–20.06), respectively. The study was limited by sample size. Conclusions Dental health status and the number and type of dental procedures performed do not appear to confer a higher risk of developing a CSF-diverting shunt infection in this pediatric population.

scholarly journals Characterization of cerebrospinal fluid (CSF) microbiota from patients with CSF shunt infection and reinfection using high throughput sequencing of 16S ribosomal RNAgenes

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0244643
Author(s):  
Kathryn B. Whitlock ◽  
Christopher E. Pope ◽  
Paul Hodor ◽  
Lucas R. Hoffman ◽  
David L. Limbrick ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
High Throughput ◽  
High Throughput Sequencing ◽  
Bacterial Species ◽  
Shunt Infection ◽  
Rrna Genes ◽  
Csf Shunt ◽  
Rrna Gene ◽  
Infection Treatment ◽  
Csf Shunt Infection

Background Nearly 20% of patients with cerebrospinal fluid (CSF) shunt infection develop reinfection. It is unclear whether reinfections are caused by an organism previously present or are independent infection events. Objective We used bacterial culture and high throughput sequencing (HTS) of 16S ribosomal RNA (rRNA) genes to identify bacteria present in serial CSF samples obtained from children who failed CSF shunt infection treatment. We hypothesized that organisms that persist in CSF despite treatment would be detected upon reinfection. Design/methods Serial CSF samples were obtained from 6 patients, 5 with 2 infections and 1 with 3 infections; the study was limited to those for which CSF samples were available from the end of infection and beginning of reinfection. Amplicons of the 16S rRNA gene V4 region were sequenced. Taxonomic assignments of V4 sequences were compared with bacterial species identified in culture. Results Seven infection dyads averaging 13.5 samples per infection were analyzed. A median of 8 taxa [interquartile range (IQR) 5–10] were observed in the first samples from reinfection using HTS. Conventional culture correlated with high abundance of an organism by HTS in all but 1 infection. In 6 of 7 infection dyads, organisms identified by culture at reinfection were detected by HTS of culture-negative samples at the end of the previous infection. The median Chao-Jaccard abundance-based similarity index for matched infection pairs at end of infection and beginning of reinfection was 0.57 (IQR 0.07–0.87) compared to that for unmatched pairs of 0.40 (IQR 0.10–0.60) [p = 0.46]. Conclusion(s) HTS results were generally consistent with culture-based methods in CSF shunt infection and reinfection, and may detect organisms missed by culture at the end of infection treatment but detected by culture at reinfection. However, the CSF microbiota did not correlate more closely within patients at the end of infection and beginning of reinfection than between any two unrelated infections. We cannot reject the hypothesis that sequential infections were independent.

Hospital Costs Associated With Shunt Infections in Patients Receiving Antibiotic-Impregnated Shunt Catheters Versus Standard Shunt Catheters

Neurosurgery ◽  
2010 ◽  
Vol 66 (2) ◽  
pp. 284-289 ◽  
Author(s):  
Frank J. Attenello ◽  
Giannina L. Garces-Ambrossi ◽  
Hasan A. Zaidi ◽  
Daniel M. Sciubba ◽  
George I. Jallo
Keyword(s):  
Hospital Cost ◽  
Pediatric Patients ◽  
Hospital Costs ◽  
The United States ◽  
Shunt Infection ◽  
Csf Shunt ◽  
Total Hospital Cost ◽  
Total Hospital ◽  
Csf Shunts ◽  
Shunt Infections

Abstract BACKGROUND The average hospital cost for shunt infection treatment is $50 000, making it the most financially costly implant-related infection in the United States. We set out to determine whether introduction of antibiotic-impregnated shunts (AISs) in our practice has decreased the incidence of shunt infection or decreased infection-related hospital costs at our institution. METHODS Clinical and hospital billing records of pediatric patients undergoing cerebrospinal fluid (CSF) shunt insertion at a single institution from April 2001 to December 2006 were retrospectively reviewed. Eighteen months before October 2002, all CSF shunts included standard, non-AIS catheters. During the 4 years after October 2002, all CSF shunts included AIS catheters. Patients were followed at least 18 months after surgery. RESULTS A total of 406 pediatric patients underwent 608 shunt placement procedures (400 AISs, 208 non-AISs). Of patients with non-AIS catheters, 25 (12%) experienced shunt infection, whereas only 13 patients (3.2%) with AIS catheters experienced shunt infection during follow-up (P &lt; .001). The total hospital cost to treat 25 non-AIS shunt infections over the first 18 months was $1,234,928. The total hospital cost to treat 13 AIS shunt infections over the past 4 years was $606,328. The mean hospital cost per shunt infection was similar for infected AIS and non-AIS catheters ($46 640 vs. $49 397). However, the infection-related hospital cost per 100 patients shunted was markedly lower in the AIS cohort than in the non-AIS cohort ($151 582 vs. $593 715). DISCUSSION The introduction of AIS catheters in our institutional practice reduced the incidence of shunt infection and resulted in significant hospital cost savings. AIS systems are efficient and cost-effective instruments to prevent perioperative colonization of CSF shunt components.

Conservative Management of Patients with Cerebrospinal Fluid Shunt Infections

Neurosurgery ◽  
2006 ◽  
Vol 58 (4) ◽  
pp. 657-665 ◽  
Author(s):  
Erwin M. Brown ◽  
Richard J. Edwards ◽  
Ian K. Pople
Keyword(s):  
Staphylococcus Aureus ◽  
Cerebrospinal Fluid ◽  
Success Rate ◽  
Conservative Management ◽  
Shunt Infection ◽  
Csf Shunt ◽  
Antibiotic Administration ◽  
Csf Shunt Infection ◽  
Shunt Infections

Abstract OBJECTIVE: In patients with cerebrospinal fluid (CSF) shunt infection, removal of the shunt and antibiotic administration is the current standard of care. In 1986, we developed a protocol for the conservative management of patients with infected but functioning shunts. Treatment was based on the administration of a combination of intraventricular and systemic antibiotics. Intraventricular antibiotics were instilled via a separate access device. The purpose of this report is to describe our experience with this therapeutic intervention. METHODS: An observational study of all patients treated for CSF shunt infection between 1986 and 2003 was undertaken. Cure was defined by sterile CSF after completion of therapy and sterile shunt components at next revision or long-term freedom from recurrent infection (follow-up period, 6–88 mo). RESULTS: In total, 43 of 122 patients with CSF shunt infections were treated conservatively according to our protocol. Overall, 84% of these patients were cured, with a 92% success rate for patients with infections caused by bacteria other than Staphylococcus aureus. This included 30 coagulase-negative staphylococcal infections, of which two were treatment failures. We abandoned conservative treatment of patients with Staphylococcus aureus infections after early experience demonstrated that the success rate (four treatment failures in seven patients) was markedly lower than that for other pathogens. During the treatment and follow-up periods, there were three deaths, two of which were unrelated to shunt infection; treatment failure could not be completely excluded in the remaining patient. There was no toxicity related to intraventricular antibiotic administration. The incidence of shunt blockage among patients who were treated conservatively was not significantly different from that among a large cohort of patients with uninfected shunts. Ten patients received part of their courses of treatment as outpatients. CONCLUSION: The success rate of conservative management of patients with CSF shunt infections caused by coagulase-negative staphylococci is comparable with those in the published literature for patients treated conventionally. This form of management avoids surgical intervention, with its attendant risks, and is safe.

Cerebrospinal fluid eosinophilia in children with ventricular shunts

2008 ◽  
Vol 1 (4) ◽  
pp. 288-295 ◽  
Author(s):  
Daniel H. Fulkerson ◽  
Joel C. Boaz
Keyword(s):  
Cerebrospinal Fluid ◽  
Shunt Infection ◽  
Common Finding ◽  
Csf Shunts ◽  
Shunt Insertion ◽  
Posthemorrhagic Hydrocephalus ◽  
Shunt Placement ◽  
Increased Risk ◽  
Using Data ◽  
Shunt Infections

Object Eosinophils have been reported in children with cerebrospinal fluid (CSF) shunts. The goal of this study was to describe the risk factors, relationship to infection, and clinical significance of CSF eosinophilia in a large group of shunt-treated patients. Methods The authors performed a retrospective review of data obtained in all patients who underwent ventricular shunt placement or revision at the James Whitcomb Riley Hospital for Children between 2000 and 2004. Results Eosinophils were identified during a follow-up shunt evaluation in 93 (31%) of 300 patients after initial shunt placement. Eosinophilia was statistically related to CSF extravasation (p < 0.0001), shunt infection (p = 0.031), blood in CSF (p < 0.0001), younger age at shunt insertion (p = 0.030), and the diagnosis of posthemorrhagic hydrocephalus (p < 0.0001). Patients with CSF eosinophilia had a higher risk of subsequent shunt failure (p < 0.0001). Analysis was performed using data obtained in a cohort of patients with a total of 130 shunt infections. Cerebrospinal fluid eosinophils were identified in 118 infections (90.8%). The leukocytic and eosinophilic reactions were dependent on the infecting organism. Propionibacterium acnes had a statistically lower CSF leukocyte count but higher differential percentage of eosinophils than the other common pathogens. Conclusions Cerebrospinal fluid eosinophilia is a relatively common finding in children with shunts. Patients with CSF eosinophilia had an increased risk of shunt malfunction in the present series. Eosinophilia is associated with infection, CSF extravasation, and blood in the CSF. Patients with P. acnes–induced shunt infections have higher eosinophil percentages than are found in infections associated with other common organisms. Therefore, in patients with eosinophilia, extended anaerobic culture studies should be performed with particular attention paid to searching for this pathogen.

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.

Operative Related Infection Rates for Ventriculoperitoneal Shunt Procedures in a Children's Hospital

1987 ◽  
Vol 8 (2) ◽  
pp. 67-70 ◽  
Author(s):  
Janara J. Younger ◽  
James C.H. Simmons ◽  
Fred F. Barrett
Keyword(s):  
Cerebrospinal Fluid ◽  
Ventriculoperitoneal Shunt ◽  
Shunt Infection ◽  
Infection Risk ◽  
Csf Shunt ◽  
Infection Rates ◽  
Surgical Infection ◽  
Shunt Procedure ◽  
Csf Shunt Infection

AbstractWe determined the operative related cerebrospinal fluid (CSF) shunt infection rates for our institution over a 3-year period (1982 to 1984) using strictly defined numerator and denominator data. The minimum post-operative follow-up period was 12 months. The average surgical infection risk for a CSF shunt procedure at our institution during the study period was 13.3%. Annual infection rates were relatively constant (13.8%, 13.2% and 12.9%), however both quarterly (5.7% to 23.3%) and surgeon-specific (5.7% to 22.8%) rates varied widely. Infection rates calculated by using “traditional” numerator and denominator data were considerably lower (6.5% to 9.2%).Operative related CSF shunt infection rates should be determined by utilizing strictly defined numerator and denominator values in order to allow valid comparisons of published rates.

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