Incidence of infection rate for shunt implantation: the zero % rate is always a myth.
Infection
Neurosurgery
Pediatric
Ventriculo peritoneal shun
Journal
Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
ISSN: 1433-0350
Titre abrégé: Childs Nerv Syst
Pays: Germany
ID NLM: 8503227
Informations de publication
Date de publication:
23 Sep 2024
23 Sep 2024
Historique:
received:
21
07
2024
accepted:
07
08
2024
medline:
23
9
2024
pubmed:
23
9
2024
entrez:
23
9
2024
Statut:
aheadofprint
Résumé
Paediatric CSF shunt infection rate remains a well-known complication that is not only responsible of potentially severe sequels for patients but also for economical expenses. In that study, we questioned if it is possible to attain the zero percent rate of infection that should be the goal of every paediatric neurosurgeon. We report our series of patients treated with a CSF device from January the first 2016 to December 31 2018. In all 147 patients treated for hydrocephalus, the follow-up was of at least of 2 years from the implantation. Antibiotic-coated tubes were always used with a differential pressure valve system. A total of 172 surgical procedures were performed for 147 patients. In the follow-up time period, 4 patients presented a post-operative infection (2.3%). Two infections appeared early after the surgical procedure one after 24 h and the other after 6 days; the other two infections were diagnosed after 53 days and the other after 66 days. The germs responsible of the infections were a Staphylococcus capitals, an Escherichia coli, a Klebsiella pneumonia, and a Staphylococcus aureus. Shunts will always be implanted especially in new-borns and for particular aetiologies of hydrocephalus. To reduce the rate of infection, the best thing to do is to adopt adapted protocols. Our low incidence of infection rate for shunts represent a long history to research preventive factors that helped us to improve our results during the time.
Identifiants
pubmed: 39311928
doi: 10.1007/s00381-024-06569-4
pii: 10.1007/s00381-024-06569-4
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s).
Références
Attenello FJ, Garces-Ambrossi GL, Zaidi HA, Sciubba DM, Jallo GI (2010) Hospital costs associated with shunt infections in patients receiving antibiotic-impregnated shunt catheters versus standard shunt catheters. Neurosurgery 66(2):284–289; discussion 289. https://doi.org/10.1227/01.NEU.0000363405.12584.4D
Mottolese C, Grando J, Convert J et al (2000) Zero rate of shunt infection in the first postoperative year in children–dream or reality? Childs Nerv Syst ChNS Off J Int Soc Pediatr Neurosurg 16(4):210–212. https://doi.org/10.1007/s003810050499
doi: 10.1007/s003810050499
Kestle JRW, Holubkov R, Douglas Cochrane D et al (2016) A new Hydrocephalus Clinical Research Network protocol to reduce cerebrospinal fluid shunt infection. J Neurosurg Pediatr 17(4):391–396. https://doi.org/10.3171/2015.8.PEDS15253
doi: 10.3171/2015.8.PEDS15253
pubmed: 26684763
Schaffzin JK, Harte L, Marquette S et al (2015) Surgical site infection reduction by the solutions for patient safety hospital engagement network. Pediatrics 136(5):e1353-1360. https://doi.org/10.1542/peds.2015-0580
doi: 10.1542/peds.2015-0580
pubmed: 26438709
Desai VR, Raskin JS, Mohan A et al (2018) A standardized protocol to reduce pediatric baclofen pump infections: a quality improvement initiative. J Neurosurg Pediatr 21(4):395–400. https://doi.org/10.3171/2017.10.PEDS17248
doi: 10.3171/2017.10.PEDS17248
pubmed: 29372853
Tipper GA, Chiwera L, Lucas J (2020) Reducing surgical site infection in pediatric scoliosis surgery: a multidisciplinary improvement program and prospective 4-year audit. Glob Spine J 10(5):633–639. https://doi.org/10.1177/2192568219868200
doi: 10.1177/2192568219868200
Kestle JRW, Riva-Cambrin J, Wellons JC et al (2011) A standardized protocol to reduce cerebrospinal fluid shunt infection: the Hydrocephalus Clinical Research Network Quality Improvement Initiative. J Neurosurg Pediatr 8(1):22–29. https://doi.org/10.3171/2011.4.PEDS10551
doi: 10.3171/2011.4.PEDS10551
pubmed: 21721884
pmcid: 3153415
Chu J, Jensen H, Holubkov R et al (2022) The Hydrocephalus Clinical Research Network quality improvement initiative: the role of antibiotic-impregnated catheters and vancomycin wound irrigation. J Neurosurg Pediatr. Published online March 18, 2022:1–8. https://doi.org/10.3171/2022.2.PEDS2214
Choux M, Genitori L, Lang D, Lena G (1992) Shunt implantation: reducing the incidence of shunt infection. J Neurosurg 77(6):875–880. https://doi.org/10.3171/jns.1992.77.6.0875
doi: 10.3171/jns.1992.77.6.0875
pubmed: 1432129
Bayston R (1994) Hydrocephalus shunt infections. J Antimicrob Chemother. 34 Suppl A:75–84
doi: 10.1093/jac/34.suppl_A.75
pubmed: 7844076
Kulkarni AV, Drake JM, Lamberti-Pasculli M (2001) Cerebrospinal fluid shunt infection: a prospective study of risk factors. J Neurosurg 94(2):195–201. https://doi.org/10.3171/jns.2001.94.2.0195
doi: 10.3171/jns.2001.94.2.0195
pubmed: 11213954
Pirotte BJM, Lubansu A, Bruneau M, Loqa C, Van Cutsem N, Brotchi J (2007) Sterile surgical technique for shunt placement reduces the shunt infection rate in children: preliminary analysis of a prospective protocol in 115 consecutive procedures. Childs Nerv Syst ChNS Off J Int Soc Pediatr Neurosurg 23(11):1251–1261. https://doi.org/10.1007/s00381-007-0415-5
doi: 10.1007/s00381-007-0415-5
Kandasamy J, Dwan K, Hartley JC et al (2011) Antibiotic-impregnated ventriculoperitoneal shunts–a multi-centre British paediatric neurosurgery group (BPNG) study using historical controls. Childs Nerv Syst ChNS Off J Int Soc Pediatr Neurosurg 27(4):575–581. https://doi.org/10.1007/s00381-010-1290-z
doi: 10.1007/s00381-010-1290-z
Thomas R, Lee S, Patole S, Rao S (2012) Antibiotic-impregnated catheters for the prevention of CSF shunt infections: a systematic review and meta-analysis. Br J Neurosurg 26(2):175–184. https://doi.org/10.3109/02688697.2011.603856
doi: 10.3109/02688697.2011.603856
pubmed: 21973061
Braga MHV, de Carvalho GTC, Brandão RACS, de Lima FBF, Costa BS (2009) Early shunt complications in 46 children with hydrocephalus. Arq Neuropsiquiatr 67(2A):273–277. https://doi.org/10.1590/s0004-282x2009000200019
doi: 10.1590/s0004-282x2009000200019
pubmed: 19547822
Feudtner C, Christakis DA, Connell FA (2000) Pediatric deaths attributable to complex chronic conditions: a population-based study of Washington State, 1980–1997. Pediatrics 106(1 Pt 2):205–209
doi: 10.1542/peds.106.S1.205
pubmed: 10888693
Albehair MA, Alosail MA, Albulwi NM et al (2021) A retrospective study on the avoidability of ventriculoperitoneal shunt infections in a university hospital in Al-Khobar, Saudi Arabia. Cureus 13(2):e13135. https://doi.org/10.7759/cureus.13135
doi: 10.7759/cureus.13135
pubmed: 33643750
pmcid: 7885735
Mallucci CL, Jenkinson MD, Conroy EJ et al (2019) Antibiotic or silver versus standard ventriculoperitoneal shunts (BASICS): a multicentre, single-blinded, randomised trial and economic evaluation. Lancet Lond Engl 394(10208):1530–1539. https://doi.org/10.1016/S0140-6736(19)31603-4
doi: 10.1016/S0140-6736(19)31603-4
Sainte-Rose C, Hooven MD, Hirsch JF (1987) A new approach in the treatment of hydrocephalus. J Neurosurg 66(2):213–226. https://doi.org/10.3171/jns.1987.66.2.0213
doi: 10.3171/jns.1987.66.2.0213
pubmed: 3543254