title: Factors contributing to the medical costs of cerebrospinal fluid shunt infection treatment in pediatric patients with standard shunt components compared with those in patients with antibiotic impregnated components.
abstract: OBJECTIVE
  Antibiotic-impregnated shunt (AIS) systems may decrease the incidence of cerebrospinal fluid (CSF) shunt infections. However, there is a reluctance to use AIS components because of their increased cost. In the present study the authors evaluated factors contributing to the medical costs associated with the treatment of CSF shunt infections in a hydrocephalic pediatric population, those implanted with AIS systems compared with those implanted with standard shunt systems.
  
  
  METHODS
  The authors retrospectively reviewed data obtained in all pediatric patients who had undergone CSF shunt insertion at their institution over a 3-year period. All patients were followed up for 12 months after surgery. The independent association between AIS catheter use and subsequent shunt infection was assessed by performing a multivariate proportional hazards regression analysis. Factors contributing to the medical costs associated with shunt infection were evaluated.
  
  
  RESULTS
  Two hundred eleven pediatric patients underwent 353 shunting procedures. Two hundred eight shunts (59%) were placed with nonimpregnated catheters and 145 shunts (41%) were placed with AIS catheters. Twenty-five patients (12%) with non-AIS catheters experienced shunt infection, whereas only two patients (1.4%) with AIS catheters had a shunt infection within the 6-month follow-up period (p < 0.01). Among infected patients, infected patients with standard shunt components had a longer average hospital stay, more inpatient complications related to infection treatment, and more multiple organism infections and multiple antibiotic regimens, compared with those with AIS components.
  
  
  CONCLUSIONS
  Although individual AIS components are more expensive than standard ones, factors contributing to medical costs are fewer in pediatric patients with infected shunts when the components are antibiotic-impregnated rather than standard.
authors.affiliation: Department of Neurosurgery, Baltimore, Maryland 21287, USA. dsciubb1@jhmi.edu <dsciubb1@jhmi.edu>
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
authors.forename: Li-Mei
authors.initials: LM
authors.lastname: Lin
authors.forename: Graeme F
authors.initials: GF
authors.lastname: Woodworth
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: McGirt
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* / Q000009:adverse effects / Q000627:therapeutic use; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects* / Q000295:instrumentation; D002648:Child; D002675:Child, Preschool; D003692:Delayed-Action Preparations; D016503:Drug Delivery Systems; D004359:Drug Therapy, Combination; D005260:Female; D017048:Health Care Costs; D006801:Humans; D015994:Incidence; D007223:Infant; D007902:Length of Stay; D008297:Male; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control* / Q000628:therapy*; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D003692:Delayed-Action Preparations