Initial experience with antibiotic-impregnated silicone catheters for shunting of cerebrospinal fluid in children.
BACKGROUND
Infection is a major complication of cerebrospinal fluid (CSF) shunting procedures. Recently, rifampin-impregnated and clindamycin-impregnated silicone catheters have been developed in an attempt to prevent and/or reduce the incidence of shunt infections. In vitro and in vivo animal studies have shown their efficacy in reducing bacterial colonization of catheters. However, these shunts are yet to be evaluated in clinical trials and their safety and efficacy in preventing shunt infections is unknown.


METHODS
Between April 2002 and April 2003, 31 children (age range 6 months to 17 years, mean 4.5 years) underwent implantation of an antibiotic-impregnated silicone catheter for CSF diversion. All surgeries were performed by a single neurosurgeon (HSM) at a single medical center. The Codman Hakim Bactiseal silicone catheter was used in all children. Thirty-two catheters were implanted in 31 children. All children have been followed since surgery (for an average of 19 months). For comparison, the previous 46 standard implanted shunts over a similar period of time were reviewed (average follow-up 31 months).


RESULTS
Of the 32 implanted catheters, 11 involved placement of a new complete shunt system, 8 were distal revisions, and 13 were proximal/ventricular revisions. There were fewer early and late complications than in the standard shunt group (12.5 and 18.8% vs. 23.9 and 34.8%). There was no local reaction from implantation of the catheters. One child contaminated his distal catheter by disrupting his abdominal incision. None of the other patients have developed any evidence of shunt infection to date.


CONCLUSIONS
Rifampin-impregnated and clindamycin-impregnated silicone catheters appear to be safe and well tolerated in children. Preliminary results suggest a low incidence of shunt infection. Longer follow-up and a larger number of patients are needed to more accurately assess the efficacy of these catheters compared with traditional silicone catheters.
Division of Neurosurgery, Children's Hospital, San Diego, CA, USA. hearyan@ucsd.edu
Henry E
HE
Aryan
Hal S
HS
Meltzer
Min S
MS
Park
Rebecca L
RL
Bennett
Rahul
R
Jandial
Michael L
ML
Levy
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002404:Catheterization / Q000295:instrumentation*; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects* / Q000295:instrumentation; D002648:Child; D002675:Child, Preschool; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012293:Rifampin / Q000008:administration & dosage*; D012828:Silicones; D013203:Staphylococcal Infections / Q000209:etiology* / Q000517:prevention & control*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D012828:Silicones; D012293:Rifampin