Evidence-based interventions to reduce shunt infections: a systematic review

Area of Science:

• Neurosurgery
• Infectious Disease Prevention
• Evidence-Based Medicine

Background:

• Cerebrospinal fluid (CSF) shunt infection leads to significant patient morbidity and healthcare costs.
• Reducing shunt infection incidence is a critical goal in neurosurgical care.

Purpose of the Study:

• To systematically review evidence on comprehensive surgical protocols and individual interventions aimed at decreasing CSF shunt infection rates.
• To identify effective strategies for preventing shunt infections.

Main Methods:

• Systematic review of PubMed and SCOPUS databases, screening 7429 articles.
• Included 23 studies evaluating interventions, excluding systemic prophylactic antibiotics or antibiotic-impregnated shunts.
• Assessed the impact of comprehensive protocols and single interventions on shunt infection risk.

Main Results:

• Comprehensive surgical protocols reduced shunt infection in all eight evaluated studies (absolute risk reduction 2.2-12.3%).
• Effective single interventions included antibiotic-impregnated sutures, no-shave policies, and double gloving with glove changes.
• Perioperative vancomycin proved superior to cefazolin in high MRSA prevalence settings.

Conclusions:

• Comprehensive surgical protocols are effective in reducing shunt infections, despite variable compliance.
• Specific interventions like antibiotic-impregnated sutures, no-shave policies, double gloving, and 5% chlorhexidine hair wash significantly lower infection rates.