The authors evaluated the safety and efficacy of antibiotic-impregnated shunt catheters (AISCs) and determined the cost–benefit ratio related to the fact that AISCs increase the implant costs of a shunt procedure by ~ $400 per patient.
The control group comprised 98 adults with chronic hydrocephalus and 22 children, who were treated without AISCs (non-AISCs). In the treatment group, AISCs (Bactiseal, Codman, Johnson & Johnson) were implanted in 171 adults and 26 children. The minimum follow-up period was 6 months.
Important risk factors for shunt infections (such as age, comorbidity, cause of hydrocephalus, operating time, and duration of external cerebrospinal fluid drainage prior to shunt placement) did not differ between the study and control groups. In the pediatric AISC group, the frequency of premature, shunt-treated infants and the incidence of external ventricular drainage prior to shunt insertion were actually higher than those in the non-AISC group. When using AISCs, the shunt infection rate dropped from 4 to 0.6% and from 13.6 to 3.8% in the adult and the pediatric cohort, respectively. Overall the infection rate decreased from 5.8 to 1%, which was statistically significant (p = 0.0145). The average costs of a single shunt infection were $17,300 and $13,000 in children and adults, respectively. The cost–benefit calculation assumed to have saved shunt infection–related costs of ~ $50,000 in 197 AISC–treated patients due to the reduction in shunt infection rate in this group compared with costs in the control group. Despite the incremental implant costs associated with the use of AISCs, the overall reduction in infection-related costs made the use of AISCs cost beneficial in the authors' department.
From clinical and economic perspectives, AISCs are seemingly a valuable addition in hydrocephalus therapy.
Abbreviations used in this paper: AISC = antibiotic-impregnated shunt catheter; CMI = Co-Morbidity Index; CSF = cerebrospinal fluid; EVD = external ventricular drainage; GAV = Gravity-Assisted Valve.
Address correspondence to: Regina Eymann, M.D., Department of Neurosurgery, Saarland University Medical School, Kirrberger Street, Building 90, 66421 Homburg-Saar, Saarland, Germany. email:
AmmiratiMRaimondiA: Cerebrospinal fluid shunt infections in children. A study of the relationship between the etiology and hydrocephalus, age at the time of shunt placement, and infection rate. Childs Nerv Syst3:106–1091987
AmmiratiM, RaimondiA: Cerebrospinal fluid shunt infections in children. A study of the relationship between the etiology and hydrocephalus, age at the time of shunt placement, and infection rate. 3:106–109, 1987)| false
KockroRAHamplJAJansenBPetersGScheihingMGiacomelliR: Use of scanning electron microscopy to investigate the prophylactic efficacy of rifampin-impregnated CSF shunt catheters. J Med Microbiol49:441–4502000
KockroRA, HamplJA, JansenB, PetersG, ScheihingM, GiacomelliR, : Use of scanning electron microscopy to investigate the prophylactic efficacy of rifampin-impregnated CSF shunt catheters. 49:441–450, 2000)| false
KohnenWSchäperJKleinOTiekeBJansenB: A silicone ventricular catheter coated with a combination of rifampin and trimethoprim for the prevention of catheter-related infections. Zentralbl Bakteriol287:147–1561998
KohnenW, SchäperJ, KleinO, TiekeB, JansenB: A silicone ventricular catheter coated with a combination of rifampin and trimethoprim for the prevention of catheter-related infections. 287:147–156, 1998)| false
SciubbaDMStuartRMMcGirtMJWoodworthGFSamdaniACarsonB: Effect of antibiotic-impregnated shunt catheters in decreasing the incidence of shunt infection in the treatment of hydrocephalus. J Neurosurg103:2 Suppl131–1362005
SciubbaDM, StuartRM, McGirtMJ, WoodworthGF, SamdaniA, CarsonB, : Effect of antibiotic-impregnated shunt catheters in decreasing the incidence of shunt infection in the treatment of hydrocephalus. 103:2 Suppl131–136, 2005)| false