Elsevier

World Neurosurgery

Volume 89, May 2016, Pages 108-111
World Neurosurgery

Original Article
Antibiotic Reservoir Injection Reduces Shunt Infection in Adults

https://doi.org/10.1016/j.wneu.2016.01.077Get rights and content

Background

Shunt infections are a major complication following ventricular shunts in adults that lead to increased heath care costs, patient morbidity, and mortality. Methods to decrease shunt infection include antibiotic-impregnated catheters, protocol-based surgery, and shunt reservoir antibiotic injection.

Methods

An Institutional Review Board–approved retrospective review was performed for all adult shunt surgeries performed from January 2000 to September 2013 at a single academic institution. Records were cross-indexed with hospital billing records to identify patients who received antibiotic injections and cross-referenced with a prospective infection control database of all surgical site infections. The primary outcome measure was shunt infection within 1 year of surgery.

Results

Five-hundred thirteen adult patients met inclusion criteria. Antibiotic reservoir injection was associated with a significantly lower rate of infection (2.6%) when compared with no injection (6.3%, P = 0.0455). The antibiotic injection group also included significantly more patients with infection risk factors than the control group (38.8% vs. 18.0%, P < 0.005).

Conclusion

Antibiotic reservoir injection is an effective method of reducing shunt infections in adults when combined with standard infection control measures.

Introduction

Shunt infections have an incidence of 5%–15% according to a recent meta-analysis and systematic reviews.1, 2 Treatment of a suspected shunt infection includes shunt removal, external ventricular drainage, antibiotic therapy, and shunt replacement. In addition to the risks of initial infection and its management, the extended hospital admission and intensive therapies escalate costs. Therefore limiting shunt infections is an important goal for improving individual patient outcomes and managing health care resources. Techniques to reduce shunt infection include the use of standardized operative protocols, antibiotic-impregnated shunt (AIS) systems,2, 3, 4 and injection of the shunt system with antibiotics.5 We sought to characterize our experience using antibiotic reservoir injections to reduce shunt infections in adults.

Section snippets

Methods

Under Institutional Review Board approval, a retrospective review of all adult ventricular shunt placements (including peritoneal, atrial, and pleural) from January 2000 to September 2013, with at least 1 year of clinical follow-up, was performed. These records were matched with operative reports and hospital billing records to identify adult patients who received intrareservoir antibiotics. Patients with previous shunt infections, active encephalitis, or meningitis were excluded. A

Results

Five-hundred thirteen adult patients met inclusion criteria. The mean age was 60 ± 18 years (range 18–90); 51% were men. The cohorts included 196 patients who received antibiotic injections, among which 5 had infections (2.6%). The control group did not receive intrareservoir antibiotics and included 313 patients, 20 of whom developed infections (6.3%). Demographic comparison is listed in Table 1. Antibiotic injections were performed on a group with significantly more risk factors for

Discussion

Perioperative antibiotic prophylaxis appears to have the strongest risk reduction for shunt placement.6, 7 AIS systems have been well studied and shown to be effective in reducing both adult and pediatric shunt infections.2, 3 One study with a similar design to ours, though involving a single surgeon, revealed infection rates of 4.0% and 1.2% before and after AIS adoption, respectively.3 Two meta-analyses have suggested that AIS systems are beneficial in reducing infections.8, 9 One randomized

Conclusion

Multiple factors contribute to the risk of shunt infection and, as such, a systematic approach should be used to mitigate as many factors as possible. In this study, shunt reservoir antibiotic injection led to lower infection rates in adult patients when combined with standardized operative techniques and protocols, even among those with increased risk for surgical site infections.

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    Conflict of interest statement: The authors have no disclosures or conflicts of interest.

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