scholarly journals Shunt Infection

2021 ◽  
Vol 3 (2(May-August)) ◽  
pp. e902021
Author(s):  
Maurice Choux
Keyword(s):  
Medical Center ◽  
Operation Time ◽  
Shunt Infection ◽  
Csf Leak ◽  
Shunt Operation ◽  
Radiological Investigation ◽  
Shunt System ◽  
Shunt Insertion ◽  
Skin Flora ◽  
Perioperative Antibiotics

The improvement in the management of hydrocephalus comes from the following:  early diagnosis, radiological investigation, better knowledge of mechanisms, quality of material, surgical technique of implantation, less shunt complications (e.g.infections) and alternatives to shunt (e.g. Neuroendoscopy). However, shunt infection does not improve in the last decades, ranging from 3 to 12%. Shunt infection can be classified in: would infection, CSF infection, infected shunt system, abdominal complications (infection).  The main agent is  Staphylococcus, causing  67%-85%  of problems, mainly due to  colonization of shunt by skin flora. The majority of cases occur during the first 2 months (85%), late infection is rare.  Risk factors to infection are the following: the cause of hydrocephalus, clinical condition and the age of children, operation time of the day, the duration of the shunt operation, the number of persons in OR, shunt material (Antibiotic catheter), presence of previously shunt system, postoperative CSF leak, perioperative antibiotics and economic level of Medical Center. Recommended management of shunt infection: removal of the shunt, insertion of an external drainage (EVD) (always in operation room), change EVD after 15 days, intravenous antibiotics, replacement of ventriculoperitoneal shunt after 3 sterile cultures. The most feared complications of Shunt infection are mortality, morbidity and cost.  In conclusion: SHUNT INFECTION IS NOT A FATALITY

Breastfeeding: a potential protective factor against ventriculoperitoneal shunt infection in young infants

2008 ◽  
Vol 1 (2) ◽  
pp. 138-141 ◽  
Author(s):  
Farideh Nejat ◽  
Parvin Tajik ◽  
Syed Mohammad Ghodsi ◽  
Banafsheh Golestan ◽  
Reza Majdzadeh ◽  
...  
Keyword(s):  
Human Milk ◽  
Protective Factor ◽  
Medical Center ◽  
Shunt Infection ◽  
Trend Test ◽  
Shunt Insertion ◽  
Vp Shunt ◽  
Young Infants ◽  
Significant Difference ◽  
Nutritional Benefits

Object Previous studies have shown nutritional benefits of breastfeeding for a child's health, especially for protection against infection. Protective factors in human milk locally and systemically prevent infections in the gastrointestinal as well as upper and lower respiratory tracts. It remains unclear whether breastfeeding protects infants against ventriculoperitoneal (VP) shunt infection. Methods A cohort study was conducted from December 2003 to December 2006 at Children's Hospital Medical Center in Tehran, Iran. A total of 127 infants with hydrocephalus who were treated using a VP shunt in the first 6 months of life were enrolled. Each infant's breastfeeding method was classified as either exclusively breastfed (EBF), combination feedings of breast milk and formula (CFBF), or exclusively formula-fed (EFF). Infants were followed up to determine the occurrence of shunt infection within 6 months after operation. Statistical analysis was performed using survival methods. Results Infants ranged in age from 4 to 170 days at the time of shunt insertion (mean 69.6 days), and 57% were males. Regarding the breastfeeding categories, 57.5% were EBF, 25.2% were CFBF, and 17.3% were EFF. During the follow-up, shunt infection occurred in 16 patients, within 15 to 173 days after shunt surgery (median 49 days). The 6-month risk of shunt infection was 8.5% (95% confidence interval [CI] 4–18%) in the EBF group, 16.5% (95% CI 7–35%) in the CFBF group, and 26.0% (95% CI 12–52%) in the EFF group. There was no statistically significant difference between these 3 groups (p = 0.11). The trend test showed a significant trend between the extent of breastfeeding and the risk of shunt infection (p = 0.035), which persisted even after adjustment for potential confounding variables (hazard ratio = 2.01, 95% CI 1.01–4). Conclusions This study supports the protective effect of breastfeeding against shunt infection during the first 6 months of life and the presence of a dose–response relationship, such that the higher the proportion of an infant's feeding that comes from human milk, the lower the incidence of shunt infection. Encouraging mothers of infants with VP shunts to breastfeed exclusively in the first 6 months of life is recommended.

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 CSF SHUNT INFECTION;

2017 ◽  
Vol 24 (01) ◽  
pp. 110-115
Author(s):  
Muhammad Sohaib Anwer ◽  
Muhammad Ali Waqas ◽  
Atta-ur-Rehman Khan
Keyword(s):  
Shunt Infection ◽  
Surgical Instruments ◽  
Definitive Treatment ◽  
Csf Shunt ◽  
Chi Square ◽  
Csf Shunts ◽  
Shunt System ◽  
Shunt Insertion ◽  
Abnormal Accumulation ◽  
Csf Shunt Infection

Hydrocephalus is the abnormal accumulation of CSF with in the ventricles andsubarachnoid spaces. It is often associated with dilatation of ventricular system and increasedICP. Hydrocephalus is almost always a result of an interruption of CSF flow and rarely becauseof increased CSF production. The definitive treatment of hydrocephalus is surgical treatmentwhich includes shunting and non-shunting procedures. The most common and overwhelmingcomplications that can occur due to the CSF shunts is infection. The risk factors associated withpediatric CSF shunt infection has been analyzed in this study. Study Design: Descriptive study.Setting: Department of Neurosurgery, Nishtar Hospital Multan & Sheikh Zayed Hospital RahimYar Khan. Period: Three years 01-07-2013 to 01-07-2016. Method: Total 209 eligible patientswho were operated for CSF shunt were keenly monitored. Several variables were observedand the responses against these variables were noted down. Post operative follow up of allthese cases done for 6 months in order to notice any development of infection (clinical signsof infection & CSF examination) in CSF shunt system. Chi-square method was used appliedin order to analyze the association among the variables and shunt infection development.Inour population of 209 patients only twenty six patients (12.44%) suffered from shunt infection.In this study four variables were qualified as having significant association with greater risk ofshunt infection. 1) Patient age. 2) Inadvertently exposure of surgical instruments to the shuntsystem. 3) the existence of large number of previous shunt systems. 4) manual handling ofshunt system Conclusions: Four variables have been reported by this study which can be agreat source of shunt infection.it is recommended that changes in clinical practice should beconsidered in order to avoid these. Few recommendations are as follows. 1) While handling theshunt system great care should be taken. 2) It should be taken care that the manual contactof the Surgeons with the shunt system should be minimum. 3) it is recommended that thealternatives other then the shunt insertion should be considered especially for the children. 4)Great number of previous shunt system is also a great risk factor and these patients must behandled as individuals at high risk.

Cerebrospinal fluid shunt infection: a prospective study of risk factors

2001 ◽  
Vol 94 (2) ◽  
pp. 195-201 ◽  
Author(s):  
Abhaya V. Kulkarni ◽  
James M. Drake ◽  
Maria Lamberti-Pasculli
Keyword(s):  
Risk Factors ◽  
Cerebrospinal Fluid ◽  
Shunt Infection ◽  
Csf Leak ◽  
Csf Shunt ◽  
Shunt System ◽  
Content Type ◽  
Increased Risk ◽  
Csf Shunt Infection ◽  
Fine Print

Object. Hydrocephalus is a common condition of childhood that usually requires insertion of a cerebrospinal fluid (CSF) shunt. Infection is one of the most devastating complications that may arise from the presence of CSF shunts. In this study, the authors prospectively analyzed perioperative risk factors for CSF shunt infection in a cohort of children. Methods. Between 1996 and 1999, 299 eligible patients underwent CSF shunt operations (insertions and revisions) that were observed by a research nurse at a tertiary care pediatric hospital. Several perioperative variables were recorded. All cases were followed postoperatively for 6 months to note any development of CSF shunt infection. A Cox proportional hazards model was used to analyze the relationship between the variables and the development of shunt infection. Thirty-one patients (10.4%) experienced shunt infection. Three perioperative variables were significantly associated with an increased risk of shunt infection: 1) the presence of a postoperative CSF leak (hazard ratio [HR] 19.16, 95% confidence interval [CI] 6.96–52.91); 2) patient prematurity (< 40 weeks' gestation at the time of shunt surgery: HR 4.72, 95% CI 1.71–13.06); and 3) the number of times the shunt system was inadvertently exposed to breached surgical gloves (HR 1.07, 95% CI 1.02–1.12). Conclusions. Three variables associated with an increased incidence of shunt infection have been identified. Changes in clinical practice should address these variables, as follows. 1) Great care should be taken intraoperatively to avoid a postoperative CSF leak. 2) Alternatives to placement of a CSF shunt in premature infants should be studied. 3) Surgeons should minimize manual contact with the shunt system and consider the use of double gloves.

scholarly journals An Indigenous Method of Securing Ventriculoperitoneal Shunt Tube in Peritoneal Cavity

2021 ◽  
Author(s):  
Samir Kumar Kalra ◽  
Krishna Shah ◽  
Sneyhil Tyagi ◽  
Suviraj John ◽  
Rajesh Acharya
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Operation Time ◽  
Complication Rates ◽  
Effective Technique ◽  
Common Procedure ◽  
Shunt System ◽  
Shunt Tube ◽  
Csf Diversion ◽  
Median Operation Time

Abstract Introduction Ventriculoperitoneal shunt (VPS) is the most common procedure used for cerebrospinal fluid (CSF) diversion in hydrocephalus. Over the years, many technical, procedural, and instrument-related advancements have taken place which have reduced the associated complication rates. Shunt block is a very common complication irrespective of the shunt system used. The abdominal end of the shunt tube gets blocked usually due to plugging of omentum onto the shunt catheter. We describe a technique of catheter fixation and placement under vision coupled with omentopexy done laparoscopically to prevent this complication. Materials and Methods This technique was used in 23 patients (11 female, 12 male; range 16–73 years) afflicted with hydrocephalus from June 2016 and December 2019 after obtaining an informed consent, and the outcomes were noted in terms of shunt patency, complications, if any, and the need for revision. Results The median operation time was 90 minutes (range 35–160 minutes). All shunt catheters were still functional after a mean follow-up of 16.5 months (range 1–34 months) and none required revision. Conclusion Laparoscopic placement of shunt tube along with omental folding is a safe and effective technique for salvaging the abdominal end of VPS and may be helpful in reducing shunt blockage.

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.

Differences in Outcome Between Open vs Laparoscopic Insertion of Ventriculoperitoneal Shunts

2021 ◽  
pp. 000313482110505
Author(s):  
Aaron B. Lopacinski ◽  
Kevin M. Guy ◽  
Jessica R. Burgess ◽  
Jay N. Collins
Keyword(s):  
Abdominal Surgery ◽  
General Surgery ◽  
Operation Time ◽  
Laparoscopic Group ◽  
Prior History ◽  
Team Approach ◽  
Tertiary Referral Hospital ◽  
Shunt Insertion ◽  
Vp Shunt ◽  
History Of

Background Abdominal access during ventriculoperitoneal (VP) shunt insertion has historically been obtained by neurosurgeons via an open abdominal approach. With recent advances in laparoscopy, neurosurgeons frequently consult general surgery for aid during the procedure. The goal of this study is to identify if laparoscopic assistance improves the overall outcomes of the procedure. Methods This retrospective study included all patients who underwent open or laparoscopic VP shunt placement between September 2012 and August 2020 at our tertiary referral hospital. Patient demographics, comorbidities, prior history of abdominal surgery, open vs. laparoscopic insertion, operation time, and complications within 30 days were obtained. Results Neurosurgery placed 107 shunts using an open abdominal technique and general surgery placed 78 using laparoscopy. The average OR time in minutes was 75.5 minutes for the open cohort and 61.8 for the laparoscopic cohort ( p = 0.006). In patients without a history of abdominal surgery, the average OR time in minutes was 79.4 in the open cohort and 57.1 in the laparoscopic cohort ( p = 0.015). The postoperative shunt infection rate was 10.2% in the open group and 3.8% in the laparoscopic group ( p = 0.077). Discussion Laparoscopic placement of VP shunts is a reasonable alternative to open placement and results in shorter OR times. There is also a trend toward few infections in the laparoscopic placement. There appears to be an advantage with a team approach and laparoscopic placement of the peritoneal portion of the shunt.

Clinical and economic consequences of antibiotic-impregnated cerebrospinal fluid shunt catheters

2008 ◽  
Vol 1 (6) ◽  
pp. 444-450 ◽  
Author(s):  
Regina Eymann ◽  
Somar Chehab ◽  
Martin Strowitzki ◽  
Wolf-Ingo Steudel ◽  
Michael Kiefer
Keyword(s):  
Cerebrospinal Fluid ◽  
Infection Rate ◽  
Operating Time ◽  
Cost Benefit ◽  
Shunt Infection ◽  
Control Group ◽  
Shunt Insertion ◽  
Shunt Procedure ◽  
Shunt Infection Rate ◽  
The Cost

Object The authors evaluated the safety and efficacy of antibiotic-impregnated shunt catheters (AISCs) and determined the cost–benefit ratio related to the fact that AISCs increase the implant costs of a shunt procedure by ~ $400 per patient. Methods The control group comprised 98 adults with chronic hydrocephalus and 22 children, who were treated without AISCs (non-AISCs). In the treatment group, AISCs (Bactiseal, Codman, Johnson & Johnson) were implanted in 171 adults and 26 children. The minimum follow-up period was 6 months. Results Important risk factors for shunt infections (such as age, comorbidity, cause of hydrocephalus, operating time, and duration of external cerebrospinal fluid drainage prior to shunt placement) did not differ between the study and control groups. In the pediatric AISC group, the frequency of premature, shunt-treated infants and the incidence of external ventricular drainage prior to shunt insertion were actually higher than those in the non-AISC group. When using AISCs, the shunt infection rate dropped from 4 to 0.6% and from 13.6 to 3.8% in the adult and the pediatric cohort, respectively. Overall the infection rate decreased from 5.8 to 1%, which was statistically significant (p = 0.0145). The average costs of a single shunt infection were $17,300 and $13,000 in children and adults, respectively. The cost–benefit calculation assumed to have saved shunt infection–related costs of ~ $50,000 in 197 AISC–treated patients due to the reduction in shunt infection rate in this group compared with costs in the control group. Despite the incremental implant costs associated with the use of AISCs, the overall reduction in infection-related costs made the use of AISCs cost beneficial in the authors' department. Conclusions From clinical and economic perspectives, AISCs are seemingly a valuable addition in hydrocephalus therapy.

Spontaneous spinal cerebrospinal fluid leaks as the cause of subdural hematomas in elderly patients on anticoagulation

2010 ◽  
Vol 112 (2) ◽  
pp. 295-299 ◽  
Author(s):  
Wouter I. Schievink ◽  
M. Marcel Maya ◽  
Brian K. Pikul ◽  
Charles Louy
Keyword(s):  
Elderly Patients ◽  
Intracranial Hypotension ◽  
Medical Center ◽  
Spontaneous Intracranial Hypotension ◽  
The Elderly ◽  
Cortical Atrophy ◽  
Csf Leak ◽  
Subdural Hematomas ◽  
Maximal Diameter ◽  
Subdural Bleeding

Subdural hematoma is a relatively common complication of long-term anticoagulation, particularly in the elderly. The combination of anticoagulation and cerebral cortical atrophy is believed to be sufficient to explain the subdural bleeding. The authors report a series of elderly patients who were on a regimen of anticoagulation and developed chronic subdural hematomas (SDHs) due to a spontaneous spinal CSF leak. They reviewed the medical records and imaging studies of a consecutive group of patients with spontaneous intracranial hypotension who were evaluated at Cedars-Sinai Medical Center. Among 141 patients with spontaneous spinal CSF leaks and spontaneous intracranial hypotension, 3 (2%) were taking anticoagulants at the time of onset of symptoms. The mean age of the 3 patients (1 woman and 2 men) was 74 years (range 68–86 years). All 3 patients had chronic SDHs measuring between 12 and 23 mm in maximal diameter. The SDHs resolved after treatment of the underlying spontaneous spinal CSF leak, and there was no need for hematoma evacuation. Epidural blood patches were used in 2 patients, and percutaneous placement of a fibrin sealant was used in 1 patient. The presence of an underlying spontaneous spinal CSF leak should be considered in patients with chronic SDHs, even among the elderly taking anticoagulants.

Ventriculoperitoneal shunt infection with Mycobacterium fortuitum: a rare offending organism

2014 ◽  
Vol 14 (6) ◽  
pp. 704-707 ◽  
Author(s):  
Gilbert Cadena ◽  
Jean Wiedeman ◽  
James E. Boggan
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Nontuberculous Mycobacteria ◽  
Treatment Strategies ◽  
Shunt Infection ◽  
Mycobacterium Fortuitum ◽  
Shunt Surgery ◽  
Time Of Surgery ◽  
Skin Flora ◽  
Ventriculoperitoneal Shunt Infection

Postsurgical infection is one of the greatest potential morbidities of ventriculoperitoneal shunt surgery. The majority of infections can be linked to contamination with skin flora at the time of surgery, a phenomenon that has been well described. However, there is a paucity of literature regarding infection with nontuberculous mycobacteria. The authors report a case of postoperative ventriculoperitoneal shunt infection with Mycobacterium fortuitum and review the available neurosurgical literature and treatment strategies.

Sign in / Sign up

Export Citation Format

Share Document