Efficacy of antibiotic-impregnated shunt catheters in reducing shunt infection: data from the United Kingdom Shunt Registry.
OBJECTIVE
In recent years CSF shunt catheters impregnated with rifampicin and clindamycin have been introduced to the United Kingdom (UK) market. These catheters have been shown to be effective in vitro against cultures of Staphylococcus epidermidis. The authors used data collected by the UK Shunt Registry to assess the efficacy of antibiotic-impregnated catheters (AICs) against shunt infection by using a matched-pair study design.


METHODS
The UK Shunt Registry contains data on nearly 33,000 CSF shunt-related procedures. The authors identified 1139 procedures in which impregnated catheters had been used, and accurate information was known about diagnosis, number of revisions, sex, and age in these cases. The database was ordered chronologically and searched forward and backward for cases with these same characteristics but involving conventional catheters. Matches were found for 994 procedures.


RESULTS
Among the 994 procedures in which AICs had been used, 30 shunts were subsequently revised because of shunt infection. Among the 994 controls, 47 were subsequently revised for infection (p = 0.048, chi-square test).


CONCLUSIONS
The UK Shunt Registry does not collect data on causative organisms, and the surgeon is relied on entirely for the diagnosis of infection. However, with the large number of matched pairs evaluated, the authors attempted to reduce bias to a minimum. Their data suggest that AICs have the potential to significantly reduce shunt infections.
United Kingdom Shunt Registry, Addenbrooke's Hospital, Cambridge, United Kingdom. hkr10@medschl.cam.ac.uk
Hugh K
HK
Richards
Helen M
HM
Seeley
John D
JD
Pickard
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002557:Cerebrospinal Fluid Shunts / Q000295:instrumentation*; D002648:Child; D002981:Clindamycin / Q000008:administration & dosage*; D020099:Coated Materials, Biocompatible; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012042:Registries; D012086:Reoperation; D012293:Rifampin / Q000009:adverse effects*; D012984:Software; D013530:Surgical Wound Infection / Q000517:prevention & control* / Q000601:surgery; D055815:Young Adult
D000900:Anti-Bacterial Agents; D020099:Coated Materials, Biocompatible; D002981:Clindamycin; D012293:Rifampin