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Topical instillation of vancomycin lowers the rate of CSF shunt infections in children

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Abstract

Introduction

Shunt surgery in pediatric patients still bears a significant risk of infection, in addition to mechanical complications of the shunt system. Antibiotic-impregnated systems and perioperative antibiotics have been extensively studied for their potential to reduce shunt infections. We examined the effectiveness of intrawound application of vancomycin powder during shunt surgery.

Patients and methods

Patient records of 78 primary shunt implantations at a mean age of 40 months were reviewed. In total, 52 patients (mean age 50 months) had been treated according to standard surgical and perioperative procedures (Std), whereas 26 patients (mean age 20 months) additionally had received topical application of vancomycin powder before wound closure (Vmc). Overall infection rate was 3.8%, in Std patients 5.8%, and in Vmc patients 0%. The rates of CSF fistula and revision surgery were similar in both groups (5.8% vs 8% and 23.1% vs. 30%, respectively).

Conclusion

To the best of our knowledge, this is the first report on topical vancomycin instillation, indicating its efficacy for the prevention of shunt infection in pediatric patients. Further studies with a higher number of patients are needed to verify this finding.

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany

    M. Krause, C. V. Mahr & U. Nestler

  2. Division of Neuroradiology, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany

    S. Schob

  3. Department of Pediatric Surgery, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany

    R. Wachowiak

Authors
  1. M. Krause
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  2. C. V. Mahr
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  3. S. Schob
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  4. U. Nestler
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  5. R. Wachowiak
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Contributions

All authors revised the manuscript carefully. CVM and MK collected the clinical data, performed the follow-up examinations, and drafted the manuscript. SS reviewed radiological examinations and sonographies.

Corresponding author

Correspondence to M. Krause.

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Conflict of interest

The authors declare no conflict of interest.

Statement of ethics

The study has been evaluated by the local ethics committee and the data analysis was approved (Ethikkommission Universität Leipzig Az 182-16/ek25042016).

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Krause, M., Mahr, C.V., Schob, S. et al. Topical instillation of vancomycin lowers the rate of CSF shunt infections in children. Childs Nerv Syst 35, 1155–1157 (2019). https://doi.org/10.1007/s00381-019-04185-1

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  • DOI: https://doi.org/10.1007/s00381-019-04185-1

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