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Published on: October 14, 2022
Shortening the perioperative prophylactic antimicrobial duration in pediatric ventriculoperitoneal (VP) shunt
Ayumi Tada1, Satoshi Ihara2, Junichi Suwa3
1Division of Infectious Diseases, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
Insights
Reducing antibiotic prophylaxis for cerebrospinal fluid (CSF) shunt insertion to 48 hours did not increase central nervous system (CNS) infection rates. This study evaluated infection incidence before and after a protocol change for VP shunt procedures.
Area of Science:
- Neurosurgery
- Infectious Disease
- Pediatric Medicine
Background:
- Central nervous system (CNS) infections are a risk after cerebrospinal fluid (CSF) shunt insertion.
- Optimal duration of perioperative antimicrobial therapy to prevent these infections is unclear.
- Institutional protocols for antibiotic prophylaxis vary, impacting patient outcomes.
Purpose of the Study:
- To evaluate the incidence of ventriculoperitoneal (VP) shunt-associated CNS infection.
- To compare infection rates before and after revising the protocol for antibiotic discontinuation within 48 hours post-surgery.
Main Methods:
- Retrospective analysis of pediatric patients (≤15 years) undergoing VP shunt insertion.
- Comparison of CNS infection incidence at 1 and 6 months post-surgery between pre- and post-intervention groups.
- Data collected from Tokyo Metropolitan Children's Medical Center between April 2014 and November 2021.
Main Results:
- No significant difference in CNS infection incidence at 1 month (7.7% vs. 7.8%, p=0.98).
- No significant difference in CNS infection incidence at 6 months (7.7% vs. 13.7%, p=0.37).
- The revised protocol did not lead to an increased infection rate.
Conclusions:
- Shortening antibiotic prophylaxis to 48 hours for VP shunt insertion is safe.
- Reduced antibiotic duration does not elevate the risk of CNS infection.
- This finding supports revising antimicrobial stewardship protocols in neurosurgery.
Background:
Perioperative antimicrobial therapy is important to prevent central nervous system (CNS) infections following cerebrospinal fluid (CSF) shunt insertion, but the optimal duration remains unclear. This study aimed to evaluate the incidence of ventriculoperitoneal (VP) shunt-associated CNS infection before and after the revision of the institutional protocol for discontinuing antimicrobial therapy within 48 h after surgery.
Methods:
Patients aged 15 years or less who underwent VP shunt insertion at Tokyo Metropolitan Children's Medical Center between April 2014 and November 2021 were enrolled retrospectively. The primary outcome was the incidence of VP shunt-associated CNS infection at postoperative months 1 and 6 in pre- and post-intervention patient groups.
Results:
Of the 117 patients screened, 27 were excluded. Of the eligible patients, 39 were in the pre-intervention group, and 51 were in the post-intervention group. The incidence of VP shunt-associated CNS infection at month 1 was 7.7% (3/39) in the pre-intervention group and 7.8% (4/51) in the post-intervention group (p = 0.98), with no significant difference. At month 6, the incidence was 7.7% (3/39) in the pre-intervention group and 13.7% (7/51) in the post-intervention group (p = 0.37), also not significantly different.
Conclusions:
Reducing the duration of antibiotic prophylaxis for VP shunt insertion to within 48 h did not increase the incidence of VP shunt-associated CNS infection.
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