Risk Factors for Ventriculoperitoneal Shunt Infection: A Systematic Review and Meta-Analysis

Background: Ventriculoperitoneal shunting (VPS) is the mainstay of treatment for most forms of hydrocephalus; VPS infection (VPSI) is a leading cause of shunt-related morbidity and mortality. A meta-analysis of the existing literature on risk factors for VPSI is currently lacking. Herein, the authors performed a systematic review and meta-analysis to evaluate the role of different clinical factors in the development of VPSI. Methods: A systematic search in the PubMed, Scopus, and Cochrane databases was performed to identify studies comparing patients developing VPSI to controls. The following data were extracted where available: number of patients who developed VPSI vs. number of patients with a regular course, demographics (gender, age at VPS insertion, age > 18 years), average length of hospital stay before shunt implant (days), aetiology of hydrocephalus (tumour-associated hydrocephalus; post-haemorrhagic hydrocephalus; congenital hydrocephalus; spinal dysraphism-associated hydrocephalus; post-infectious hydrocephalus; post-traumatic hydrocephalus; post-craniotomy hydrocephalus), and hydrocephalus type (obstructive hydrocephalus, communicating hydrocephalus, normal-pressure hydrocephalus-NPH). Results: Five studies including 2333 patients (225 with VPS infection) were analysed. Tumour-related hydrocephalus was linked to a lower infection risk (OR 0.418; p < 0.001), while congenital hydrocephalus (OR 2.502; p < 0.001) and spinal dysraphism (OR 2.359; p < 0.001) increased the risk. Conclusions: VPSI represents a serious complication after shunt surgery. Our meta-analysis identifies three key factors influencing the risk of VPSI. VPS-centred, large multicentre prospective studies are needed to possibly confirm the role of the factors we identified and to identify additional ones, enabling earlier detection of VPSI and allowing for better patient care.