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Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Surgical shunt infection: significant reduction when using intraventricular and systemic antibiotic agents
Brian T Ragel1, Samuel R Browd, Richard H Schmidt
1Department of Neurosurgery, University of Utah Health Sciences Center, Salt Lake City, Utah 84132-2303, USA.
Object:
Infection represents the most common serious complication of shunt surgery, and typically its incidence ranges between 5 and 15%, despite the use of systemic antibiotic agents. Because systemic antibiotic medications generally penetrate the cerebrospinal fluid (CSF) poorly, the authors investigated, in a controlled study, whether the addition of intraventricular antibiotic treatment decreases the incidence of perioperative infection in adult patients.
Methods:
Data pertaining to all CSF shunt procedures conducted at the authors' institution during an 11-year period were reviewed. Perioperative infection was defined as culture-positive CSF and the clinical presence of infection-related symptoms occurring within 90 days of surgery. All patients underwent intraoperative systemic antistaphylococcal antibiotic therapy. Before May 16, 1999, the senior author (R.H.S.) also administered 4 mg of gentamicin intraventricularly at surgery (Group I); thereafter, 10 mg of vancomycin was additionally administered (Group II). Other neurosurgeons at this institution did not use intraventricular antibiotic therapy, and their patients served as additional controls in identical time periods (Groups III and IV). A total of 802 shunt procedures were performed in 534 patients. Control infection rates were 5.4% (eight of 147) in Group I; 6.2% (nine of 145) in Group III; and 6.7% (18 of 267) in Group IV. With the combination of systemic antibiotic and intraventricular gentamicin and vancomycin (Group II), the infection rate fell significantly to 0.4% (one of 243). No complications were noted in association with intraventricular antibiotic administration.
Conclusions:
The combination of intraventricular gentamicin and vancomycin with systemic antibiotic therapy significantly decreased the incidence of perioperative shunt infection. It is presumed that intraventricular antibiotic therapy extends prophylactic antibiotic coverage into the CSF and prevents bacterial seeding.
Insights
Adding intraventricular gentamicin and vancomycin to systemic antibiotics significantly reduced shunt infection rates. This targeted approach improves cerebrospinal fluid (CSF) antibiotic levels, preventing serious post-surgical infections.
Area of Science:
- Neurosurgery
- Infectious Disease
- Pharmacology
Background:
- Shunt surgery complications include infection, with incidence rates of 5-15% despite systemic antibiotics.
- Systemic antibiotics poorly penetrate cerebrospinal fluid (CSF), limiting their effectiveness in preventing shunt infections.
Purpose of the Study:
- To investigate if intraventricular antibiotic administration reduces perioperative infection rates in adult patients undergoing shunt surgery.
Main Methods:
- A retrospective review of 802 shunt procedures over 11 years.
- Patients received systemic antibiotics; Group I received intraventricular gentamicin, Group II received intraventricular vancomycin, and Groups III/IV served as controls without intraventricular antibiotics.
- Perioperative infection was defined as culture-positive CSF and symptoms within 90 days.
Main Results:
- Control groups (I, III, IV) had infection rates of 5.4% to 6.7%.
- Group II, receiving combined systemic and intraventricular gentamicin/vancomycin, showed a significantly reduced infection rate of 0.4%.
- No complications were associated with intraventricular antibiotic administration.
Conclusions:
- Combined intraventricular and systemic antibiotic therapy significantly decreases perioperative shunt infection incidence.
- Intraventricular antibiotics likely enhance prophylactic coverage within the CSF, preventing bacterial seeding.
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