title: Effect of antibiotic-impregnated shunt catheters in decreasing the incidence of shunt infection in the treatment of hydrocephalus.
abstract: OBJECTIVE
  The majority of shunt infections occur within 6 months of shunt placement and chiefly result from perioperative colonization of shunt components by skin flora. Antibiotic-impregnated shunt (AIS) systems have been designed to prevent such colonization. In this study, the authors evaluate the incidence of shunt infection after introduction of an AIS system in a population of children with hydrocephalus.
  
  
  METHODS
  The authors retrospectively reviewed all pediatric patients who had undergone cerebrospinal fluid (CSF) shunt insertion at their institution over a 3-year period between April 2001 and March 2004. During the 18 months prior to October 2002, all CSF shunts included standard, nonimpregnated catheters. During the 18 months after October 2002, all CSF shunts included antibiotic-impregnated catheters. All patients were followed up for 6 months after shunt surgery, and all shunt-related complications, including shunt infection, were evaluated. The independent association of AIS catheter use with subsequent shunt infection was assessed via multivariate proportional hazards regression analysis. A total of 211 pediatric patients underwent 353 shunt placement procedures. In the 18 months prior to October 2002, 208 (59%) shunts were placed with nonimpregnated catheters; 145 (41%) shunts were placed with AIS catheters in the 18 months after October 2002. Of patients with nonimpregnated catheters, 25 (12%) experienced shunt infection, whereas only two patients (1.4%) with antibiotic-impregnated catheters experienced shunt infection within the 6-month follow-up period (p < 0.01). Adjusting for intercohort differences via multivariate analysis, AIS catheters were independently associated with a 2.4-fold decreased likelihood of shunt infection.
  
  
  CONCLUSIONS
  The AIS catheter significantly reduced incidence of CSF shunt infection in children with hydrocephalus during the early postoperative period (< 6 months). The AIS system used is an effective instrument to prevent perioperative colonization of CSF shunt components.
authors.affiliation: Department of Neurosurgery and Division of Pediatric Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland 21287, USA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
authors.forename: R Morgan
authors.initials: RM
authors.lastname: Stuart
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: McGirt
authors.forename: Graeme F
authors.initials: GF
authors.lastname: Woodworth
authors.forename: Amer
authors.initials: A
authors.lastname: Samdani
authors.forename: Benjamin
authors.initials: B
authors.lastname: Carson
authors.forename: George I
authors.initials: GI
authors.lastname: Jallo
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001424:Bacterial Infections / Q000517:prevention & control*; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D020099:Coated Materials, Biocompatible / Q000627:therapeutic use*; D004867:Equipment Design; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000517:prevention & control
chemical_list: D000900:Anti-Bacterial Agents; D020099:Coated Materials, Biocompatible