A multicenter multinational registry for assessing ventriculoperitoneal shunt infections for hydrocephalus.
BACKGROUND
Reported infection rates after ventriculoperitoneal shunt surgery vary from 1 to 25%. Antibiotic-impregnated (AI) catheters may reduce shunt infection rates, but this is uncertain.


OBJECTIVE
To establish a prospective shunt registry to evaluate short-term (3-month) infection rates associated with ventriculoperitoneal shunts and standard or AI catheters during surgical treatment of hydrocephalus.


METHODS
A prospective, multicenter, noncontrolled, open-label registry investigated patients with de novo catheter implantation or catheter replacement of an existing ventriculoperitoneal shunt. The primary outcome was shunt infection.


RESULTS
A total of 440 patients were entered into the registry at 10 sites: 3 in North America, 2 in Singapore, 4 in China and 1 in India. Seven patients were excluded. Of the 433 remaining patients, 314 had new shunts and 119 were revisions. Shunt infections occurred in 14 of 433 patients (3.2%) overall and in 2 of 37 infants (5.2%) younger than 1 year. AI catheters were used in 46 of 433 patients at 7 centers. The shunt infection rate was 0 of 46 for shunts with AI catheters and 14 of 387 (3.6%) without AI catheters. Infection rates were similar with AI catheters, adjusting for age and catheter type.


CONCLUSIONS
The overall shunt infection rate was lower than in previous multicentered studies. The low infection rate and low rate of AI catheter use precludes any meaningful statement regarding the value of AI catheters in reducing the infection rate. Consideration should be given to performing a well designed, adequately powered, prospective randomized controlled trial to determine whether AI catheters reduce shunt infection rates.
Steinbok
Paul
P
Division of Neurosurgery, Department of Surgery, University of British Columbia, and BC Children's Hospital, Vancouver, British Columbia, Canada. psteinbok@cw.bc.ca
Milner
Ruth
R
Agrawal
Deepak
D
Farace
Elana
E
Leung
Gilberto K K
GK
Ng
Ivan
I
Tomita
Tadanori
T
Wang
Ernest
E
Wang
Ning
N
Wong
George Kwok Chu
GK
Zhou
Liang Fu
LF
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000453:epidemiology* / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016459:Prosthesis-Related Infections / Q000453:epidemiology*; D012042:Registries / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D017287:Ventriculoperitoneal Shunt / Q000706:statistics & numerical data*; D055815:Young Adult