Long-term analysis of cerebrospinal fluid shunt infections

A 25-year experience

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✓ The authors have retrospectively analyzed 840 cerebrospinal fluid shunting procedures over a 25-year period to determine the relationships between infection rates and several possible influences on infection. Two-thirds of all shunt infections occurred within 1 month of surgery. The very young and very old had higher infection rates. Infections became less prevalent over the period of the study, and mortality from infection decreased from 35% to 6%. Successive shunts (revisions) were found to have progressively higher infection rates. Ventriculoatrial and ventriculoperitoneal silicone plastic shunts had similar infection rates (11.4% and 12.0%). The uncontrolled use of prophylactic antibiotics had no effect on shunt infections. Staphylococcus epidermidis became gradually more prevalent over the period of the study, and eventually caused one-half of all infections. Where infection occurred in the presence of prophylaxis, the infectious organism was usually sensitive to the antibiotic being used. The surgeon was found to be the largest single factor in the incidence of shunt infections. A 25-fold variance in infection rates among surgeons could be related to individual experience and technique.

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Figures

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    Average follow-up period in months plotted against each individual year of the study.

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    Postoperative time of occurrence of shunt infections. (Accumulation of all shunt infections plotted against the time after surgery in months.)

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    Percentage of each year's shunting procedures that became infected, plotted against the year the shunts were performed.

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    Average shunt infection rate for all shunts (broken line), and plastic shunts (unbroken line), calculated for each shunt in patient's series of shunts. Significance of difference: 1 vs 2: p < 0.09; 2 vs 3: p < 0.03;* 2 vs 4: p < 0.01;* 2 vs 4: p < 0.05.* (* = significant difference.)

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    Relative prevalence of each organism causing shunt infections per year. Band width reflects proportional prevalence of each organism.

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