title: Revision surgeries are associated with significant increased risk of subsequent cerebrospinal fluid shunt infection.
abstract: BACKGROUND
  The object of this study was to determine whether cerebrospinal fluid (CSF) shunt revision(s) are associated with increased risk of CSF shunt infection, after adjusting for baseline factors that contribute to infection risk.
  
  
  METHODS
  This was a retrospective cohort study of 579 children aged 0-18 years who underwent initial CSF shunt placement between January 01, 1997 and October 12, 2006 at a tertiary care children's hospital. The outcome of interest was CSF shunt infection. Data for all subsequent CSF shunt revisions leading up to and including the initial CSF shunt infection, when applicable, were obtained. The likelihood of infection was determined using a Cox proportional hazard model accounting for patient characteristics and CSF shunt revisions, and is reported using hazard ratios (HR) with 95% confidence intervals (CI).
  
  
  RESULTS
  There were 123 children who developed infection. Baseline factors independently associated with hazard of infection included age 0 to <6 months at CSF shunt placement (HR 2.4, 95% CI: 1.02-6.7) and myelomeningocele (HR 0.4, 95% CI: 0.2-0.8). Controlling for baseline factors, the risk of infection after shunt revision was significantly greater than at the time of initial placement (HR 3.0, 95% CI: 1.9-4.7), and this risk increased as numbers of revisions increased (≥2 revisions HR 6.5, 95% CI: 3.6-11.4).
  
  
  CONCLUSIONS
  Although younger age is associated with increased hazard of infection, subsequent CSF shunt revision significantly increases infection risk.
authors.affiliation: Department of Pediatrics, University of Washington/ Seattle Children's Hospital, Seattle, WA, USA. Tamara.Simon@seattlechildrens.org
authors.forename: Tamara D
authors.initials: TD
authors.lastname: Simon
authors.forename: Kathryn B
authors.initials: KB
authors.lastname: Whitlock
authors.forename: Jay
authors.initials: J
authors.lastname: Riva-Cambrin
authors.forename: John R W
authors.initials: JR
authors.lastname: Kestle
authors.forename: Margaret
authors.initials: M
authors.lastname: Rosenfeld
authors.forename: J Michael
authors.initials: JM
authors.lastname: Dean
authors.forename: Richard
authors.initials: R
authors.lastname: Holubkov
authors.forename: Marcie
authors.initials: M
authors.lastname: Langley
authors.forename: Nicole Mayer
authors.initials: NM
authors.lastname: Hamblett
mesh_terms: D000293:Adolescent; D002555:Cerebrospinal Fluid / Q000382:microbiology*; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012086:Reoperation / Q000009:adverse effects*; D012189:Retrospective Studies; D018570:Risk Assessment; D013530:Surgical Wound Infection / Q000453:epidemiology*