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Bacterial contamination in cerebrospinal fluid shunt surgery
Abstract:
Infection is a major complication of cerebrospinal fluid (CSF) shunt treatment with a reported incidence of 8-27%. In the present study, comprising 64 patients operated under strictly defined preoperative and peroperative hygienic measures and without use of prophylactic antibiotics, the infection rate was 3.1%. Out of the 2 cases of shunt infection recorded, 1 was probably caused by peroperative contamination and 1 by postoperative, hematogenous spread. Bacterial cultures from the operation area before incision and during operation were negative in 95% and 78%, respectively, and when positive yielded low numbers of organisms. Specimens taken after skin closure revealed growth in 59% and high bacterial numbers in 20%, mostly of Staphylococcus epidermidis and other resident skin bacteria. In addition, cultures of irrigation solutions, kept in open bowls during operation, yielded bacterial growth in 65% with a predominance of S. epidermidis. Thus, the strict hygienic measures did not prevent bacterial recolonization of the wound during operation. It is conceivable that endogenous as well as exogenous spread may be of importance in this context. The contamination of irrigation solutions indicates that closed irrigation systems should be used in this type of surgery.
Insights
Strict hygienic measures reduced cerebrospinal fluid (CSF) shunt infection rates to 3.1%. However, wound contamination persisted, suggesting improved irrigation systems are needed to prevent infections.
Area of Science:
- Neurosurgery
- Infectious Disease
- Medical Device Safety
Background:
- Cerebrospinal fluid (CSF) shunt infections are a significant complication, occurring in 8-27% of cases.
- Preventing shunt infections is crucial for patient outcomes and reducing healthcare costs.
Purpose of the Study:
- To evaluate the infection rate in patients undergoing CSF shunt surgery with strict hygienic protocols and no prophylactic antibiotics.
- To identify sources of bacterial contamination during the surgical procedure.
Main Methods:
- Prospective study of 64 patients undergoing CSF shunt surgery.
- Implementation of strict preoperative and peroperative hygienic measures.
- Bacterial cultures from the operation area, wound specimens, and irrigation solutions.
Main Results:
- The infection rate was significantly reduced to 3.1% (2 out of 64 patients).
- Bacterial contamination was detected in irrigation solutions (65%) and after skin closure (59%), predominantly by Staphylococcus epidermidis.
- Strict hygiene measures did not fully prevent wound recolonization, indicating potential for endogenous and exogenous spread.
Conclusions:
- Strict hygienic measures can substantially lower CSF shunt infection rates.
- Open irrigation systems are a likely source of bacterial contamination.
- Closed irrigation systems are recommended to further reduce infection risk in CSF shunt surgery.