title: Comparative effectiveness of antibiotic-impregnated shunt catheters in the treatment of adult and pediatric hydrocephalus: analysis of 12,589 consecutive cases from 287 US hospital systems.
abstract: OBJECTIVE
  The real-world effectiveness of antibiotic-impregnated shunt catheters to reduce the incidence of shunt infections is still debated. The literature to date consists mostly of small, single-institution studies. The aim of this study was to assess the incidence of infection for antibiotic-impregnated catheters (AICs) versus standard shunt catheters in a large nationwide administrative database.
  
  
  METHODS
  The authors retrospectively reviewed hospital discharge and billing records from the Premier Perspective Database from April 2003 to July 2009 to identify all adult and pediatric patients undergoing de novo ventricular shunt placement. The primary end point was the incidence of shunt infection within 1 year of implantation. Multivariate logistical regression was performed to determine factors associated with increased incidence of infection.
  
  
  RESULTS
  A total of 10,819 adult (AIC, 963; standard catheter, 9856) and 1770 pediatric (AIC, 229; standard catheter, 1541) patients underwent ventricular shunt placement in 287 US hospitals. Overall, the incidence of infection was 3.5% in adults (n=380) and 6.6% in pediatric patients (n=116). AICs were associated with significant reduction in infection for both adult (2.2% vs 3.6%, p=0.02) and pediatric (2.6% vs 7.1%, p<0.01) patients. AIC use was associated with reduced infection regardless of hospital size, annual shunt volume, hospital location, or patient risk factors and remained associated with a reduced infection in multivariate analysis for both adult (p=0.02) and pediatric (p=0.02) patients.
  
  
  CONCLUSIONS
  The use of antibiotic-impregnated shunt catheters was associated with a reduction in shunt infections for both adult and pediatric patients. This provides further support that AICs may represent a reliable means of reducing shunt infections for both adult and pediatric patients.
authors.affiliation: Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee;
authors.forename: Scott L
authors.initials: SL
authors.lastname: Parker
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: McGirt
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Murphy
authors.forename: J Thomas
authors.initials: JT
authors.lastname: Megerian
authors.forename: Michael
authors.initials: M
authors.lastname: Stout
authors.forename: Luella
authors.initials: L
authors.lastname: Engelhart
mesh_terms: D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000453:epidemiology / Q000517:prevention & control*; D057785:Catheters / Q000382:microbiology*; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects* / Q000295:instrumentation; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000628:therapy*; D015994:Incidence; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: AIC = antibiotic-impregnated catheter; HIPAA = Health Insurance Portability and Accountability Act; ICD-9 = International Classification of Diseases, Ninth Revision; antibiotic impregnated; hydrocephalus; infection; shunt