Antibiotic-impregnated shunt catheters decrease the incidence of shunt infection in the treatment of hydrocephalus.

Daniel M Sciubba MD, George I Jallo MD
Department of Neurological Surgery, Johns Hopkins University, Baltimore, USA
E-mail: E-mail: gjallo1@jhmi.edu

BACKGROUND: Most shunt infections occur within 6 months of shunt placement and chiefly result from perioperative colonization by skin flora. Antibiotic-impregnated shunt (AIS) systems have been designed to prevent such colonization. In this study, we evaluate incidence of shunt infection after introduction of an AIS system in a pediatric hydrocephalus population.

METHODS: We retrospectively reviewed all pediatric patients undergoing CSF shunt insertion at our institution over a 3-year period. During 18 months prior to October 2002, CSF shunts included standard, non-impregnated shunt catheters. During the 18 months following October 2002, CSF shunts included antibiotic-impregnated shunt catheters. Patients were followed for 6 months after surgery, and all shunt-related complications, including infection, were evaluated. The independent association of antibiotic-impregnated shunt catheter use with subsequent shunt infection was assessed via multivariate proportional hazards regression analysis.

RESULTS: 147 pediatric patients underwent 325 shunting procedures. 181 (56%) shunts were placed with non-impregnated catheters prior to October 2002. 144 (44%) shunts were placed with antibiotic-impregnated shunt catheters after October 2002. Sixteen (9%) patients with non-impregnated catheters experienced shunt infection, whereas only three (2%) patients with antibiotic-impregnated catheters experienced shunt infection within the 6-month follow-up period, p = 0.025. Antibiotic-impregnated shunt catheters, adjusting for inter-cohort differences via multivariate analysis, were independently associated with a 3.5-fold decreased likelihood of shunt infection.

CONCLUSION: The antibiotic-impregnated shunt catheter significantly reduced incidence of CSF shunt infection in children with hydrocephalus during the early postoperative period (less than 6 months). The AIS system used is an effective instrument to prevent perioperative colonization of CSF shunt components.

Contains all the abstracts in .pdf format (201 Kb)