Clinical and economic consequences of antibiotic-impregnated cerebrospinal fluid shunt catheters.
OBJECTIVE
The authors evaluated the safety and efficacy of antibiotic-impregnated shunt catheters (AISCs) and determined the cost-benefit ratio related to the fact that AISCs increase the implant costs of a shunt procedure by approximately $400 per patient.


METHODS
The control group comprised 98 adults with chronic hydrocephalus and 22 children, who were treated without AISCs (non-AISCs). In the treatment group, AISCs (Bactiseal, Codman, Johnson & Johnson) were implanted in 171 adults and 26 children. The minimum follow-up period was 6 months.


RESULTS
Important risk factors for shunt infections (such as age, comorbidity, cause of hydrocephalus, operating time, and duration of external cerebrospinal fluid drainage prior to shunt placement) did not differ between the study and control groups. In the pediatric AISC group, the frequency of premature, shunt-treated infants and the incidence of external ventricular drainage prior to shunt insertion were actually higher than those in the non-AISC group. When using AISCs, the shunt infection rate dropped from 4 to 0.6% and from 13.6 to 3.8% in the adult and the pediatric cohort, respectively. Overall the infection rate decreased from 5.8 to 1%, which was statistically significant (p = 0.0145). The average costs of a single shunt infection were $17,300 and $13,000 in children and adults, respectively. The cost-benefit calculation assumed to have saved shunt infection-related costs of approximately $50,000 in 197 AISC-treated patients due to the reduction in shunt infection rate in this group compared with costs in the control group. Despite the incremental implant costs associated with the use of AISCs, the overall reduction in infection-related costs made the use of AISCs cost beneficial in the authors' department.


CONCLUSIONS
From clinical and economic perspectives, AISCs are seemingly a valuable addition in hydrocephalus therapy.
Department of Neurosurgery, Saarland University Medical School, Saarland, Germany. Regina.Eymann@uks.eu
Regina
R
Eymann
Somar
S
Chehab
Martin
M
Strowitzki
Wolf-Ingo
WI
Steudel
Michael
M
Kiefer
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002408:Catheters, Indwelling / Q000191:economics*; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D016503:Drug Delivery Systems / Q000191:economics*; D006801:Humans; D006849:Hydrocephalus / Q000628:therapy*; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents