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Repeat cerebrospinal fluid shunt infection in children
A V Kulkarni1, D Rabin, M Lamberti-Pasculli
1Division of Neurosurgery, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
Insights
The risk of repeat cerebrospinal fluid (CSF) shunt infection (RSI) in children is substantial, with a 24.4% risk plateauing at 90 days. Further research with larger sample sizes is needed to identify specific risk factors.
Area of Science:
- Pediatric Neurosurgery
- Infectious Diseases
- Clinical Research
Background:
- Cerebrospinal fluid (CSF) shunt infections are a significant complication in pediatric hydrocephalus management.
- Understanding the risk factors for repeat shunt infection (RSI) is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the treatment of initial shunt infections (ISI) in children.
- To identify risk factors associated with repeat shunt infections (RSI) within six months of ISI.
Main Methods:
- A retrospective review of 51 children treated for CSF shunt infection between 1996 and 2000.
- Analysis of medical records to identify cases of RSI and evaluate potential risk factors using survival analysis.
Main Results:
- Coagulase-negative Staphylococcus and Staphylococcus aureus were the most common infecting organisms.
- The actuarial risk of RSI reached a plateau of 24.4% at 90 days.
- No statistically significant risk factors for RSI were identified in this cohort.
Conclusions:
- The risk of repeat shunt infection is considerable, necessitating further investigation.
- Larger sample sizes are required to achieve sufficient statistical power for identifying RSI risk factors.
Background:
In this study, we investigated the treatment of cerebrospinal fluid (CSF) shunt infection and the risk factors for repeat shunt infection (RSI) in a cohort of children treated at the Hospital for Sick Children, Toronto, Canada.
Methods:
Between 1996 and 2000, a total of 51 children were identified with shunt infection (mean age 5.8 years). The medical records of these children were reviewed to identify cases of RSI within 6 months of the initial shunt infection (ISI).
Results:
In the 51 ISIs, the infecting organisms were coagulase-negative Staphylococcus (43.1%), Staphylococcus aureus (37.3%) and others (19.6%). The initial mode of treatment of the shunt infection was using an external ventricular drain (EVD) with removal of the shunt apparatus (54.9%), externalization of the shunt (37.3%) or shunt removal only (7.8%). The mean number of days of external CSF drainage (either EVD or externalized shunt) was 11.2 days. Ten patients (19.6%) developed RSI. The actuarial risk of RSI plateaued after 90 days at 24.4%. The following variables were tested as risk factors for RSI using survival analysis, although none reached statistical significance: initial organism (p = 0.09), age (p = 0.42), etiology of hydrocephalus (p = 0.45), number of days of CSF drainage (p = 0.45), type of surgical treatment of the ISI (p = 0.58) and the presence of bacteriologically positive CSF at ISI (p = 0.85).
Conclusions:
The risk of RSI is substantial and greater effort needs to be directed towards understanding the risk factors. Such studies will need a greater sample size in order to obtain sufficient statistical power.
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