title: Cerebrospinal shunt infection in patients receiving antibiotic-impregnated versus standard shunts.
abstract: OBJECTIVE
  Cerebrospinal fluid shunt infections are associated with significant morbidity and mortality in the treatment of adult and pediatric hydrocephalus. Antibiotic-impregnated shunt (AIS) catheters have been used with the aim of reducing shunt infection. While many studies have demonstrated a reduction in shunt infection with AIS, this reported efficacy has varied within the literature.
  
  
  METHODS
  The authors performed a systematic literature review to identify all published articles comparing the incidence of CSF shunt infection in AIS versus non-AIS catheters. The incidence of infection for AIS versus non-AIS catheters was calculated using the Mantel-Haenszel common odds ratio, and baseline demographics were compared between AIS and non-AIS cohorts.
  
  
  RESULTS
  Twelve AIS versus non-AIS cohort comparisons were identified in the literature (5 pediatric hydrocephalus, 3 adult hydrocephalus, and 4 mixed populations). In a total of 5613 reported shunt procedures (2664 AISs vs 2949 non-AISs), AISs were associated with a reduction in shunt infection (3.3% vs 7.2%; OR 0.439, p < 0.0001). In 787 shunt procedures for adult hydrocephalus (427 AIS vs 360 non-AIS), AISs were associated with reduction in shunt infection (0.9% vs 5.8%; OR 0.153, p < 0.0001). In 1649 shunt procedures for pediatric hydrocephalus (854 AIS vs 795 non-AIS), AISs were associated with reduction in shunt infection (5.0% vs 11.2%; OR 0.421, p < 0.0001).
  
  
  CONCLUSIONS
  The authors' systematic review of the literature demonstrates that AIS catheters are associated with a significant reduction over non-AIS catheters in the reported incidence of CSF shunt infection in adult and pediatric populations. The AIS catheters do not appear to be associated with an increased incidence of antibiotic-resistant microorganisms. Prospective, randomized trials are needed to firmly assess and confirm this apparent difference in infection incidence.
authors: The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors: Scott L
authors: SL
authors: Parker
authors: William N
authors: WN
authors: Anderson
authors: Sean
authors: S
authors: Lilienfeld
authors: J Thomas
authors: JT
authors: Megerian
authors: Matthew J
authors: MJ
authors: McGirt
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D002648:Child; D006801:Humans; D006849:Hydrocephalus / Q000453:epidemiology* / Q000601:surgery*; D015994:Incidence; D016459:Prosthesis-Related Infections / Q000453:epidemiology* / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents