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Indian Society of Pediatric Neurosurgery Consensus Guidelines on Preventing and Managing Shunt Infection: Version
Suhas Udayakumaran1, Shibu Pillai2, Srinivas Dwarakanath3
1Division of Paediatric Neurosurgery, Department of Neurosurgery, Amrita Institute Of Medical Sciences and Research Centre, Kochi, Kerala, India.
Insights
Shunt infection is a major complication of shunt surgery. This study developed region-specific guidelines for preventing and managing shunt infections in low and middle-income countries, despite limited high-level evidence.
Area of Science:
- Neurosurgery
- Infectious Disease Epidemiology
- Clinical Guidelines Development
Background:
- Shunt infection represents the most significant morbidity following shunt surgery.
- Existing literature lacks region and resource-specific recommendations for shunt infection prevention and management.
Purpose of the Study:
- To formulate practical guidelines for shunt infection prevention and management tailored for India and other low and middle-income countries (LMICs).
Main Methods:
- A Guidelines Development Group (GDG) was formed by the Indian Society of Paediatric Neurosurgery (IndSPN).
- Methods included an initial email survey of practices, a systematic literature review, and virtual GDG meetings over one year.
- The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was employed to assess evidence and recommendation strength.
Main Results:
- The developed guidelines are structured into eight distinct sections.
- Limited Level I and Level II evidence supported only five recommendations, resulting in moderate recommendation levels.
- The majority of evidence was Level III or below, leading to low or very low recommendation levels; consensus was crucial for several issues.
Conclusions:
- Despite reliance on low-level evidence for most recommendations, these guidelines offer a valuable reference for neurosurgeons in India and other LMICs.
- The guidelines require periodic updates as new evidence becomes available.
Background:
Shunt infection is the most significant morbidity associated with shunt surgery. Based on the existing literature for the prevention and management of shunt infection, region and resource-specific recommendations are needed.
Methods:
In February 2020, a Guidelines Development Group (GDG) was created by the Indian Society of Paediatric Neurosurgery (IndSPN) to formulate guidelines on shunt infections, which would be relevant to our country and LMIC in general. An initial email survey identified existing practices among the membership of the IndSPN, and eight broad issues pertaining to shunt infection were identified. Next, members of the GDG performed a systematic review of the literature on the prevention and management of shunt infection. Then, through a series of virtual meetings of the GDG over 1 year, evidence from the literature was presented to all the members and consensus was built on different aspects of shunt infection. Finally, the guidelines document was drafted and circulated among the GDG for final approval. Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to grade the evidence and strength of recommendation.
Results:
The guidelines are divided into eight sections. Level I and Level II evidence was available for only five recommendations and led to a moderate level of recommendations. Most of the available evidence was at Level III and below, and hence the level of recommendation was low or very low. A consensus method was used to provide recommendations for several issues.
Conclusions:
Although most of the recommendations for the prevention and management of shunt infections are based on a low level of evidence, we believe that this document will provide a useful reference to neurosurgeons not only in India but also in other low and middle income countries. These guidelines need to be updated as and when new evidence emerges.
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