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Reducing the incidence of infection in pediatric cerebrospinal fluid shunt operations
K Rotim1, P Miklic, J Paladino
1Department of Neurosurgery, KBC Zagreb, Croatia. NRK-KBC@ZG.TEL.HR
Insights
Implementing a new shunt protocol significantly reduced infection rates in pediatric hydrocephalus patients. The revised approach focused on antibiotic prophylaxis and meticulous surgical techniques, lowering infections from 9.4% to 5.3% per procedure.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Infectious Disease
Background:
- Shunt infections are a significant complication in pediatric hydrocephalus management.
- Previous infection rates in shunt procedures were high, necessitating improved protocols.
Purpose of the Study:
- To evaluate the impact of a new protocol on shunt infection rates in pediatric hydrocephalus patients.
- To assess the effectiveness of modified perioperative and intraoperative management strategies.
Main Methods:
- A retrospective review of shunt implantation procedures in children with hydrocephalus was conducted.
- Data from two distinct time periods were compared: pre-protocol (1985-1990) and post-protocol implementation (1991-1995).
- The new protocol included enhanced antibiotic prophylaxis and meticulous surgical techniques.
Main Results:
- The incidence of shunt infection per procedure decreased from 9.4% to 5.3% after protocol implementation.
- The per-patient infection rate also saw a reduction.
- Staphylococcus epidermidis was identified as the most common causative agent in shunt infections.
Conclusions:
- The revised shunt protocol effectively reduced the incidence of shunt infections in pediatric hydrocephalus.
- Meticulous surgical technique and perioperative antibiotic prophylaxis are crucial for preventing shunt-related infections.
- Further research into specific prophylactic measures against Staphylococcus epidermidis may be warranted.
Abstract:
We reviewed our experience with shunt implantation during two time periods. From June 1985 to December 1990, 201 children with hydrocephalus underwent 382 operations. Among these children 36 (18%) developed a proven shunt infection, with an incidence rate per procedure of 9.4%. As a result of this study, a new effective protocol for shunt procedures involving modifications to the perioperative (antibiotic prophylaxis) and intraoperative management (meticulous surgical technique, complete shunt revision) of children undergoing initial shunt implantation or revision was initiated. With this new protocol 75 children underwent a total of 112 procedures between January 1991 and December 1995. The incidence of shunt infection decreased, with a per patient rate of 8% and a per procedure rate of 5.3%. The majority of infections in our study were caused by Staphylococcus epidermidis, which was found in 22 (52.3%) patients.