Original ArticleAntibiotic Reservoir Injection Reduces Shunt Infection in Adults
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.
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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.