Patient and Treatment Characteristics by Infecting Organism in Cerebrospinal Fluid Shunt Infection
Tamara D Simon1,2, Matthew P Kronman1,2, Kathryn B Whitlock2
1Department of Pediatrics, University of Washington/Seattle Children's Hospital, Washington.
Insights
Antibiotic-impregnated catheters in cerebrospinal fluid (CSF) shunts are linked to a higher proportion of Gram-negative bacilli infections. Further research is needed due to the increasing use of these catheters in pediatric shunt infections.
Area of Science:
- Pediatric Neurosurgery
- Infectious Diseases
- Medical Device Technology
Background:
- Previous studies on cerebrospinal fluid (CSF) shunt infection treatment lacked the size to compare patient and treatment characteristics by infecting organism.
- Limited data exists on how infecting organisms influence treatment and patient characteristics in pediatric CSF shunt infections.
Purpose of the Study:
- To describe patient and treatment variations in children with their first CSF shunt infection.
- To stratify these variations by infecting organism subgroups according to 2017 Infectious Disease Society of America (IDSA) guidelines.
Main Methods:
- A prospective cohort study of 145 children under 18 years old treated for their first CSF shunt infection.
- Data collected from 7 Hydrocephalus Clinical Research Network hospitals between April 2008 and December 2012.
- Univariate analyses and Fisher's exact tests were used to compare infecting organism subgroups.
Main Results:
- No significant differences in patient or treatment characteristics were observed across infecting organism subgroups (Staphylococcus aureus, coagulase-negative Staphylococcus, Gram-negative bacilli, Propionibacterium acnes).
- A higher proportion of Gram-negative bacilli infections occurred when antibiotic-impregnated catheters were used during initial shunt placement or revisions (52% and 48%, respectively) compared to non-impregnated catheters (13% and 19%).
- No differences in reinfection rates were found between the infecting organism subgroups.
Conclusions:
- The organism profile of CSF shunt infections changes with the use of antibiotic-impregnated catheters, showing an increased prevalence of Gram-negative bacilli.
- This shift necessitates further investigation due to the growing adoption of antibiotic-impregnated catheters in clinical practice.
Background:
Previous studies of cerebrospinal fluid (CSF) shunt infection treatment have been limited in size and unable to compare patient and treatment characteristics by infecting organism. Our objective was to describe variation in patient and treatment characteristics for children with first CSF shunt infection, stratified by infecting organism subgroups outlined in the 2017 Infectious Disease Society of America's (IDSA) guidelines.
Methods:
We studied a prospective cohort of children <18 years of age undergoing treatment for first CSF shunt infection at one of 7 Hydrocephalus Clinical Research Network hospitals from April 2008 to December 2012. Differences between infecting organism subgroups were described using univariate analyses and Fisher's exact tests.
Results:
There were 145 children whose infections were diagnosed by CSF culture and addressed by IDSA guidelines, including 47 with Staphylococcus aureus, 52 with coagulase-negative Staphylococcus, 37 with Gram-negative bacilli, and 9 with Propionibacterium acnes. No differences in many patient and treatment characteristics were seen between infecting organism subgroups, including age at initial shunt, gender, race, insurance, indication for shunt, gastrostomy, tracheostomy, ultrasound, and/or endoscope use at all surgeries before infection, or numbers of revisions before infection. A larger proportion of infections were caused by Gram-negative bacilli when antibiotic-impregnated catheters were used at initial shunt placement (12 of 23, 52%) and/or subsequent revisions (11 of 23, 48%) compared with all other infections (9 of 68 [13%] and 13 of 68 [19%], respectively). No differences in reinfection were observed between infecting organism subgroups.
Conclusions:
The organism profile encountered at infection differs when antibiotic-impregnated catheters are used, with a higher proportion of Gram-negative bacilli. This warrants further investigation given increasing adoption of antibiotic-impregnated catheters.
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