The impact of antibiotic-impregnated catheters on shunt infection in children and neonates.
BACKGROUND
Infection remains a significant problem with cerebrospinal fluid (CSF) diversion procedures. Antibiotic-impregnated shunt catheters (AIS) have been introduced to prevent infection, mainly in the early post-operative period when most infections occur. We evaluate the impact on infection rates in children following the introduction of catheters impregnated with rifampicin and clindamycin.


METHODS
The study was a retrospective analysis of all paediatric shunt procedures undertaken after the introduction of AIS systems in 2003. All procedures where a complete AIS system was implanted were included. For the purpose of analysis, shunt procedures were classified as de novo (group 1), clean revision (group 2) and following external ventricular drainage with either sterile CSF (group 3) or infected CSF (group 4). Results were compared to a historical cohort of shunt procedures undertaken before the introduction of AIS catheters.


RESULTS
A total of 214 AIS were implanted in 150 children between October 2003 and December 2006. There were 4 infections in group 1 (8.5%), 6 infections in group 2 (5.3%) and 11 infections in groups 3 and 4 (20%). The historical control group comprised 77 shunts in 65 children. The infection rate in neonatal de novo shunts reduced from 27 to 10.4% following the introduction of AIS catheters.


CONCLUSIONS
AIS catheters can reduce the number of shunt infections seen in clinical practice in certain subgroups. This has had a significant impact on the neonatal hydrocephalic population. The high risk of shunt infection after a period of external ventricular drainage raises the issue of emergence of bacterial resistance.
Hayhurst
Caroline
C
Department of Neurosurgery, The Walton Centre for Neurology and Neurosurgery, Lower Lane, Fazakerley, Liverpool, UK. carolinehayhurst@hotmail.com
Cooke
Richard
R
Williams
Dawn
D
Kandasamy
Jothy
J
O'Brien
Donncha F
DF
Mallucci
Conor L
CL
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016459:Prosthesis-Related Infections / Q000134:cerebrospinal fluid / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control*; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents