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Poor Surgical Outcomes Following Paenibacillus Infant Infectious Hydrocephalus
Insights
Paenibacillus detection in infant cerebrospinal fluid (CSF) is linked to worse hydrocephalus outcomes. Infants with Paenibacillus had higher rates of diversion failure, death, and overall adverse events after surgery.
Area of Science:
- Pediatric Neurosurgery
- Infectious Diseases
- Clinical Microbiology
Background:
- Postinfectious hydrocephalus (PIH) is a significant concern in infants, particularly in regions like Eastern Uganda.
- Previous research identified Paenibacillus species in a substantial percentage of infants with PIH.
Purpose of the Study:
- To compare surgical outcomes in infants with postinfectious hydrocephalus (PIH) based on the presence or absence of Paenibacillus in cerebrospinal fluid (CSF).
Main Methods:
- A prospective observational study involved 78 infants with PIH and positive CSF Paenibacillus polymerase chain reaction (PP) and 111 with negative results (PN).
- The primary outcome was diversion failure-free survival, with secondary outcomes including overall survival and diversion success.
- Median follow-up was 35.7 months.
Main Results:
- Paenibacillus detection was associated with significantly higher rates of diversion failure or death (aHR, 2.45; P=0.001).
- Patients with Paenibacillus had increased mortality (aHR, 3.47; P=0.006) and diversion failure (aHR, 2.24; P=0.003).
- Endoscopic diversion in PP patients showed the worst primary event rate (aHR, 6.47; P<0.001).
Conclusions:
- Paenibacillus detection in CSF at hydrocephalus surgery correlates with worse patient outcomes.
- This association is particularly pronounced in infants undergoing endoscopic diversion procedures.
- Findings highlight the potential impact of Paenibacillus on hydrocephalus treatment efficacy and prognosis.
Objective:
We previously identified Paenibacillus species in the cerebrospinal fluid of 44% of infants presenting for neurosurgical evaluation with findings consistent with postinfectious hydrocephalus (PIH) in Eastern Uganda. Here we sought to compare outcomes among hydrocephalic infants with and without Paenibacillus detection at the time of hydrocephalus surgery.
Methods:
In a prospective observational study, 78 infants with PIH who underwent a cerebrospinal fluid (CSF) diversion prior to 90 days of age had a positive CSF polymerase chain reaction result for Paenibacillus species (PP), and 111 had a negative result (PN). The primary outcome was diversion failure-free survival defined as being alive without diversion failure at last patient contact. Secondary outcomes included overall survival and diversion success.
Results:
After a median follow-up period of 35.7 months, the primary outcome was observed in 42 PP patients (54%) and in 76 PN patients (68%) (adjusted hazard ratio (aHR), 2.45; 95% confidence interval [CI], 1.42 to 4.22; P=0.001). PP patients who underwent endoscopic diversion had the worst primary event rate (aHR, 6.47; 95% CI, 2.40 to 17.42; P<0.001). Death from any cause occurred in 16 PP patients (20%) and 9 PN patients (8%) (aHR, 3.47; 95% CI, 1.44 to 8.37; P=0.006). Diversion failure occurred in 28 PP patients (36%) and in 29 PN patients (26%) (aHR, 2.24; 95% CI, 1.31 to 3.85; P=0.003).
Conclusions:
In this study, Paenibacillus detection in the CSF at the time of hydrocephalus surgery was associated with a significantly increased rate of the composite of diversion failure or death, death, and diversion failure, and was particularly increased for patients who had an endoscopic diversion.
