Ventriculoperitoneal shunt infection: insights from a single-center comparative analysis

Area of Science:

• Neurosurgery
• Infectious Disease Prevention
• Surgical Site Infections

Background:

• Ventriculoperitoneal (VP) shunting is a common procedure for hydrocephalus.
• Shunt-related infections are a significant complication, with ongoing debate about contributing factors.
• Peri-operative skin preparation is a critical element in preventing surgical site infections.

Purpose of the Study:

• To compare the efficacy of povidone-iodine versus 2% chlorhexidine gluconate-alcohol for pre-operative skin preparation in VP shunting.
• To identify factors influencing shunt infection rates in a clinical practice setting.

Main Methods:

• A comparative study involving 54 hydrocephalus patients undergoing VP shunting.
• Patients were randomized into two groups: Group I (povidone-iodine) and Group II (2% chlorhexidine gluconate-alcohol) for skin preparation.
• Standardized prophylactic antibiotics, irrigation fluid, shunt systems, and sutures were used across both groups. Patients were followed for 6 months for infection.

Main Results:

• Overall, 14 (25.9%) patients developed post-operative infections.
• Group I had an infection rate of 30.0% (9/30), while Group II had 20.8% (5/24).
• No statistically significant difference in infection rates was observed between the two skin preparation agents (p=0.445). Factors like surgeon cadre, surgery duration, gender, and BMI did not significantly impact infection occurrence.

Conclusions:

• The choice of skin preparation agent (povidone-iodine vs. chlorhexidine-alcohol) did not significantly affect ventriculoperitoneal shunt infection rates.
• Recommendations for pre-operative skin antisepsis in VP shunting should consider surgeon preference, agent efficacy, and cost.
• Further research may explore other preventative strategies for shunt infections.