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Updated: Jun 8, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Antibiotic-impregnated ventriculoperitoneal shunts--a multi-centre British paediatric neurosurgery group (BPNG) study
Jothy Kandasamy1, Kerry Dwan, John C Hartley
1Department of Paediatric Neurosurgery, Alder Hey, Royal Liverpool Children's University Hospital NHS Trust, Liverpool, UK.
Insights
Antibiotic-impregnated shunt (AIS) systems may reduce infection rates in paediatric hydrocephalus patients. This multi-centre study suggests AIS shunts are more effective than standard shunts, but more research is needed.
Area of Science:
- Neurosurgery
- Paediatric Medicine
- Infectious Disease
Background:
- Ventriculoperitoneal shunt infection is a significant challenge in paediatric hydrocephalus management.
- Antibiotic-impregnated shunt (AIS) systems offer a potential solution, but robust evidence is lacking.
- Previous studies yielded inconsistent results on AIS efficacy.
Purpose of the Study:
- To evaluate the efficacy of AIS systems in preventing shunt infections in paediatric patients.
- To compare infection rates between AIS and non-AIS shunts across multiple institutions.
Main Methods:
- A multi-centre historical control study involving three paediatric neurosurgical units.
- Data from 581 AIS implantations and 1,963 non-AIS implantations were analyzed.
- Shunt infection rates were compared using meta-analysis, with a focus on de novo and clean revision procedures, including an infant subgroup.
Main Results:
- AIS shunts showed a clinical advantage in reducing infection rates compared to non-AIS shunts (OR 0.60).
- The de novo infant subgroup also demonstrated a significant reduction in infection rates with AIS shunts (OR 0.38).
- Gram-positive organisms were predominant in infections, with a median onset of 19 days.
Conclusions:
- Multi-centre data suggest AIS systems significantly reduce shunt infection rates in paediatric patients.
- While promising, potential bias exists due to the historical control design.
- Further double-blinded randomized controlled trials are necessary to confirm AIS efficacy.
Background:
Ventriculoperitoneal shunt infection remains a significant problem. The introduction of antibiotic-impregnated shunt (AIS) systems in the prevention of shunt infection may represent a potential advance; however, there are no randomized controlled trials to establish a robust evidence-based practice. Previously published single-institution cohort studies have provided varying results on the efficacy of AIS systems in the prevention of shunt infection. In this study, we evaluate combined outcomes from three paediatric neurosurgical units in the use of AIS systems for paediatric patients with hydrocephalus.
Methods:
The three units established independent databases with data collected from varying time frames. All procedures, where a complete AIS system or part was implanted into patients from 0-16 years in age, were included. The primary outcome measure was shunt infection rate. Shunt procedures were classified as de novo (DNS) and clean revision (CRS). An infant (<1 year) de novo insertion subgroup was also analyzed. AIS shunts were compared to a historical control of non-AIS shunts and results were analysed by centre using an odds ratio with a 95% confidence interval and combined across centres by meta-analysis.
Results:
A total of 581 AIS implantation procedures were performed in all three units. The comparative non-AIS historical cohort comprised of 1,963 procedures. The pooled effect estimate indicated a clinical advantage for AIS shunts compared to non-AIS shunts, odds ratio (OR), 0.60 (95% CI 0.38, 0.93). The de novo infant group comprised 153 AIS systems, and 465 de novo shunts in the historical non-AIS cohort. Again the pooled effect estimate indicated a clinical advantage for AIS shunts compared to non-AIS shunts, OR 0.38 (95% CI, 0.17; 0.85); however, there was a large overlap of confidence intervals in the results from the different sites indicating the uncertainty in the treatment effect estimates. Over 80% of organisms were gram positive in the infected AIS cohort with a median time to infection of 19 days. Two rifampicin-resistant organisms and three MRSA organisms were detected.
Conclusion:
Data from this exclusively paediatric multi-centre historical control study suggest that AIS may significantly reduce infection rates in de novo and clean revision shunt implants. Although the possibility of bias cannot be excluded due to study design, this is the largest study on an exclusively paediatric cohort comparing standard shunts to AIS implants. Future double-blinded RCTs are needed to confirm AIS efficacy.
