Cerebrospinal shunt infection in patients receiving antibiotic-impregnated versus standard shunts

A review

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  • 1 The Johns Hopkins University School of Medicine, Baltimore, Maryland;
  • 2 Consulting Statistician, Lake Forest, California;
  • 3 Codman & Shurtleff, Johnson & Johnson, Raynham, Massachusetts; and
  • 4 Department of Neurosurgery, Vanderbilt University School of Medicine, Nashville, Tennessee
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Object

Cerebrospinal fluid shunt infections are associated with significant morbidity and mortality in the treatment of adult and pediatric hydrocephalus. Antibiotic-impregnated shunt (AIS) catheters have been used with the aim of reducing shunt infection. While many studies have demonstrated a reduction in shunt infection with AIS, this reported efficacy has varied within the literature.

Methods

The authors performed a systematic literature review to identify all published articles comparing the incidence of CSF shunt infection in AIS versus non-AIS catheters. The incidence of infection for AIS versus non-AIS catheters was calculated using the Mantel-Haenszel common odds ratio, and baseline demographics were compared between AIS and non-AIS cohorts.

Results

Twelve AIS versus non-AIS cohort comparisons were identified in the literature (5 pediatric hydrocephalus, 3 adult hydrocephalus, and 4 mixed populations). In a total of 5613 reported shunt procedures (2664 AISs vs 2949 non-AISs), AISs were associated with a reduction in shunt infection (3.3% vs 7.2%; OR 0.439, p < 0.0001). In 787 shunt procedures for adult hydrocephalus (427 AIS vs 360 non-AIS), AISs were associated with reduction in shunt infection (0.9% vs 5.8%; OR 0.153, p < 0.0001). In 1649 shunt procedures for pediatric hydrocephalus (854 AIS vs 795 non-AIS), AISs were associated with reduction in shunt infection (5.0% vs 11.2%; OR 0.421, p < 0.0001).

Conclusions

The authors' systematic review of the literature demonstrates that AIS catheters are associated with a significant reduction over non-AIS catheters in the reported incidence of CSF shunt infection in adult and pediatric populations. The AIS catheters do not appear to be associated with an increased incidence of antibiotic-resistant microorganisms. Prospective, randomized trials are needed to firmly assess and confirm this apparent difference in infection incidence.

Abbreviations used in this paper: AIS = antibiotic-impregnated shunt; EVD = external ventricular drain.

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Contributor Notes

Current affiliation for Dr. Parker: Department of Neurosurgery, Vanderbilt University School of Medicine, Nashville, Tennessee.

Address correspondence to: Matthew J. McGirt, M.D., 4347 Village at Vanderbilt, Nashville, Tennessee 37232-8618. email: matt.mcgirt@vanderbilt.edu.
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