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Effects of Intraventricular Vancomycin Administration on the Prevention of Ventricular Shunt Infection
Mohammad Hasanpour1, Hamid Rezaee2, fARIBORZ Samini3
1neurosurgery, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of).
Insights
Intraventricular (IVT) vancomycin effectively reduced shunt infection rates in pediatric hydrocephalus surgery. This finding supports its inclusion in surgical protocols to prevent postoperative infections and improve patient outcomes.
Area of Science:
- Neurosurgery
- Pediatric Infectious Diseases
- Medical Microbiology
Background:
- Shunt infection is a serious complication in hydrocephalus treatment, leading to increased morbidity, mortality, and healthcare costs.
- Pediatric patients with hydrocephalus often require re-operations due to shunt dysfunction or infection, highlighting the need for effective preventive strategies.
Purpose of the Study:
- To evaluate the efficacy of intraventricular (IVT) vancomycin in preventing shunt infections in children undergoing hydrocephalus surgery.
- To compare shunt infection and obstruction rates between children receiving IVT vancomycin and a control group.
Main Methods:
- A descriptive cross-sectional study involving 192 pediatric patients with hydrocephalus who underwent shunt surgery.
- Patients were divided into an intervention group (n=69) receiving 30 mg of IVT vancomycin and a control group (n=123).
- Comparison of shunt infection, obstruction, and mortality rates between the two groups.
Main Results:
- The shunt infection rate was significantly lower in the IVT vancomycin group (8.8%) compared to the control group (18.2%) (P=0.04).
- No significant differences were observed in shunt obstruction (P=0.056) or mortality rates (P=0.95) between the groups.
- Demographic and developmental outcomes were comparable between the intervention and control groups.
Conclusions:
- Intraventricular vancomycin administration during hydrocephalus surgery appears to be an effective measure for reducing postoperative shunt infections.
- The findings suggest that IVT vancomycin should be considered for inclusion in standard surgical protocols for hydrocephalus.
- Further multicenter prospective randomized controlled trials are recommended to confirm the efficacy of IVT antibiotics in reducing ventriculoperitoneal shunt infections.
Introduction And Objectives:
Shunt infection causes death in many patients diagnosed with hydrocephalus and increases the duration of hospitalization and treatment costs. A high percentage of children are forced to undergo re-surgery due to shunt dysfunction or infection. The present study aimed to investigate the role of intraventricular (IVT) vancomycin in the prevention of ventricular shunt infection in children with hydrocephalus who were referred to Akbar Hospital in Mashhad, Iran, between the years 2017 and 2021.
Materials And Methods:
The present descriptive cross-sectional study was conducted on 192 children with hydrocephalus who underwent shunt surgery at Akbar Hospital in Mashhad, Iran, between the years 2017 and 2021. Patients were divided into two groups of intervention (n=69) and control (n=123). The patients in the intervention group received 30 mg of IVT vancomycin during shunt surgery. The rate of shunt obstruction and infection were then compared between the two study groups.
Results:
The two study groups were matched in terms of demographic and clinical information except for gender (P=0.02). Moreover, no significant difference was reported between the two groups in terms of intelligence development (χ2=0.51; P=0.47), verbal development (χ2=0.1; P=0.75), and movement development (χ2=1.05; P=0.3). The frequency of shunt infection and shunt obstruction was estimated at 8.8% and 18.2%, respectively. The shunt infection rate was lower in the vancomycin IVT group than in the control group (χ2=4.07; P=0.04), while no difference was observed between the two groups in terms of shunt obstruction (χ2=3.66; P=0.056). The comparison of the two study groups indicated no significant difference between them in terms of mortality (χ2=0.004; P=0.95).
Conclusion:
It seems that IVT vancomycin should be recommended for inclusion in hydrocephalus surgery protocol to reduce postoperative shunt infection. It is recommended that shunt protocols be adopted in future multicenter prospective randomized controlled trials on the reduction of ventriculoperitoneal shunt infections to further evaluate the efficacy of IVT antibiotics.
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