title: Ventriculoatrial Shunts in Adults, Incidence of Infection, and Significant Risk Factors: A Single-Center Experience.
abstract: BACKGROUND
  In recent years, the number of ventriculoatrial (VA) shunt insertions has decreased worldwide, the major cause being the risk of shunt infection. VA shunts remain as an alternative option to ventriculoperitoneal shunts. We describe our 10-year experience with VA shunts by analyzing the incidence of shunt infections and predisposing cofactors.
  
  
  METHODS
  During a median follow-up of 15.3 months, 259 shunt insertions, performed on 255 patients, were analyzed. The infection rate was calculated and the predisposing cofactors age, gender, cause of the hydrocephalus, previous external ventricle drainage, antibiotic-impregnated catheters, the number of revisions, the educational level of the surgeons, and the duration of the operations were analyzed. Two observation times were stratified.
  
  
  RESULTS
  We found overall infections in 18 patients (7.1%), 16 deep infections (6.3%) including 1 shunt nephritis (0.4%) and 2 superficial infections (0.8%). Wound dehiscence occurred in 17 patients (6. 6%). Analyzing follow-up time, the infection rate was 3.65% (95% confidence interval, 0.9%-5.9%) at survival time 1, 3.38% (95% confidence interval, 1.1%-6.2%) at survival time 2. In the first 6 months, 95% of patients were free of infection. Only the number of revision procedures was associated with the number of infections (P value < 0.0005).
  
  
  CONCLUSIONS
  In our patient cohort, the infection rate related to VA shunt insertion is low; the only statistically significant risk factor was the number of revisions. If the VA shunt is applied following a standardized protocol, the infection risk does not represent an argument for reluctance towards the VA draining concept.
authors.affiliation: Neurosurgical Department, Paracelsus Medical University, Salzburg, Austria. Electronic address: a.al-schameri@salk.at.
authors.forename: Abdul Rahman
authors.initials: AR
authors.lastname: Al-Schameri
authors.affiliation: Neurological Department, Medical University of Vienna, Vienna, Austria.
authors.forename: Jasmina
authors.initials: J
authors.lastname: Hamed
authors.affiliation: University Hospital, Neuroradiology Department, Zurich, Switzerland.
authors.forename: Gerasimos
authors.initials: G
authors.lastname: Baltsavias
authors.affiliation: Neurosurgical Department, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Peter
authors.initials: P
authors.lastname: Winkler
authors.affiliation: Neurosurgical Department, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Lukas
authors.initials: L
authors.lastname: Machegger
authors.affiliation: Paracelsus Medical University, Salzburg, Austria.
authors.forename: Bernd
authors.initials: B
authors.lastname: Richling
authors.affiliation: Neurosurgical Department, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Stephan
authors.initials: S
authors.lastname: Emich
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001317:Austria / Q000453:epidemiology; D055499:Catheter-Related Infections / Q000175:diagnosis / Q000453:epidemiology*; D015984:Causality; D015897:Comorbidity; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000453:epidemiology* / Q000628:therapy*; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009443:Neuritis / Q000175:diagnosis / Q000453:epidemiology*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000453:epidemiology*; D017287:Ventriculoperitoneal Shunt / Q000706:statistics & numerical data*
keywords: Adults; Complication; Hydrocephalus; Infection; Ventriculoatrial shunt