Risk factors for cerebrospinal fluid shunt infections during an outbreak: a case-control study

Area of Science:

• Neurosurgery
• Infectious Disease Epidemiology
• Healthcare Quality Improvement

Background:

• Cerebrospinal fluid (CSF) shunt infections are rare, with few reported outbreaks.
• British Columbia Children's Hospital (BCCH) observed an unusual rise in CSF shunt infections between 2017-2018.
• This increase coincided with a relocation to new operating rooms and a change in shunt catheter type.

Purpose of the Study:

• To detail the detection and investigation of a CSF shunt infection outbreak.
• To identify risk factors associated with shunt infections during the outbreak period.
• To document interventions implemented to control the outbreak.

Main Methods:

• A retrospective case-control study design was employed.
• Patients undergoing new shunt insertion or revision were included in the analysis.
• Univariate logistic regression identified potential risk factors (P-value <0.2).

Main Results:

• Six cases of CSF shunt infection and 19 controls were analyzed.
• Causative organisms varied among cases; no single pathogen was identified.
• Potential risk factors included being a neonate and having gastrointestinal disease; no link to operating room or staff was found.

Conclusions:

• No modifiable risk factors were definitively linked to the CSF shunt infections.
• Implementation of enhanced surgical protocols led to the cessation of further outbreak-related infections.
• The study highlights the importance of protocol adherence in preventing shunt infections.