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Initial experience with antibiotic-impregnated silicone catheters for shunting of cerebrospinal fluid in children
Henry E Aryan1, Hal S Meltzer, Min S Park
1Division of Neurosurgery, Children's Hospital, San Diego, CA, USA. hearyan@ucsd.edu
Insights
Antibiotic-impregnated silicone catheters for cerebrospinal fluid (CSF) shunting show promise in reducing infections in children. Preliminary results indicate safety and a low incidence of shunt infection, warranting further investigation.
Area of Science:
- Neurosurgery
- Infectious Disease
- Biomaterials
Background:
- Cerebrospinal fluid (CSF) shunting is prone to infection, a significant complication.
- Antibiotic-impregnated silicone catheters (rifampin and clindamycin) have been developed to mitigate shunt infections.
- Previous in vitro and animal studies demonstrated reduced bacterial colonization, but clinical data were lacking.
Purpose of the Study:
- To evaluate the safety and efficacy of antibiotic-impregnated silicone catheters in pediatric CSF shunting.
- To assess the incidence of shunt infections and complications associated with these novel catheters.
Main Methods:
- A prospective study of 31 children (6 months to 17 years) receiving 32 antibiotic-impregnated silicone catheters (Codman Hakim Bactiseal) between April 2002 and April 2003.
- Surgical procedures performed by a single neurosurgeon at one medical center.
- Comparison with a retrospective cohort of 46 children who received standard shunts.
Main Results:
- Fewer early (12.5%) and late (18.8%) complications were observed compared to the standard shunt group (23.9% and 34.8%).
- No local reactions to the implanted catheters were reported.
- No shunt infections occurred in the study group, except for one case of distal catheter contamination due to an abdominal incision disruption.
Conclusions:
- Antibiotic-impregnated silicone catheters appear safe and well-tolerated in pediatric patients undergoing CSF shunting.
- Preliminary findings suggest a reduced incidence of shunt infections.
- Further long-term studies with larger patient cohorts are necessary to definitively establish efficacy compared to traditional catheters.
Introduction:
Infection is a major complication of cerebrospinal fluid (CSF) shunting procedures. Recently, rifampin-impregnated and clindamycin-impregnated silicone catheters have been developed in an attempt to prevent and/or reduce the incidence of shunt infections. In vitro and in vivo animal studies have shown their efficacy in reducing bacterial colonization of catheters. However, these shunts are yet to be evaluated in clinical trials and their safety and efficacy in preventing shunt infections is unknown.
Methods:
Between April 2002 and April 2003, 31 children (age range 6 months to 17 years, mean 4.5 years) underwent implantation of an antibiotic-impregnated silicone catheter for CSF diversion. All surgeries were performed by a single neurosurgeon (HSM) at a single medical center. The Codman Hakim Bactiseal silicone catheter was used in all children. Thirty-two catheters were implanted in 31 children. All children have been followed since surgery (for an average of 19 months). For comparison, the previous 46 standard implanted shunts over a similar period of time were reviewed (average follow-up 31 months).
Results:
Of the 32 implanted catheters, 11 involved placement of a new complete shunt system, 8 were distal revisions, and 13 were proximal/ventricular revisions. There were fewer early and late complications than in the standard shunt group (12.5 and 18.8% vs. 23.9 and 34.8%). There was no local reaction from implantation of the catheters. One child contaminated his distal catheter by disrupting his abdominal incision. None of the other patients have developed any evidence of shunt infection to date.
Conclusion:
Rifampin-impregnated and clindamycin-impregnated silicone catheters appear to be safe and well tolerated in children. Preliminary results suggest a low incidence of shunt infection. Longer follow-up and a larger number of patients are needed to more accurately assess the efficacy of these catheters compared with traditional silicone catheters.