Advertisement

Acta Neurochirurgica

, Volume 136, Issue 1–2, pp 1–7 | Cite as

Risk of infection after cerebrospinal fluid shunt: An analysis of 884 first-time shunts

  • B. M. Borgbjerg
  • F. Gjerris
  • M. J. Albeck
  • S. E. Børgesen
Review Article

Summary

Postoperative infections are major complications of cerebrospinal fluid (CSF) shunting in the treatment of hydrocephalus and other conditions with obstructed CSF circulation. In a retrospective study 884 first-time shunted patients with hydrocephalus operated on in the years 1958–1989 were investigated with special reference to the infection rate and to the influence of the following variables: time period, age of the patient, education of the neurosurgeon, length and time of the operation and the exact placement of the distal drain.

The overall infection rate for all implanted CSF shunts was 7.4% (5.7–9.3%) and the acute rate of infection was 6.2% (4.6–7.9%). The rate of infection was virtually constant for all variables with the exception of the education of the neurosurgeon. Neurosurgical trainees particularly had a significantly higher rate of infection.

Shunt infection is still a major complication. The infection rate has not declined in recent decades. It is not possible to relate any main cause to the infection rate. The literature recommends removal of the infected shunt combined with antibiotics. The use of prophylactic antibiotics is still controversial. No prospective, double-blind studies, including a sufficiently large number of patients to evaluate this issue, exist today.

Keywords

Cerebrospinal fluid shunts complications hydrocephalus infections 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Ajir F, Levin AB, Duff TA (1981) Effect of prophylactic methicillin on cerebrospinal fluid shunt infections in children. Neurosurgery 9: 6–9PubMedGoogle Scholar
  2. 2.
    Amacher AL, Wellington J (1984) Infantile hydrocephalus: long-term results of surgical therapy. Childs Brain 11: 217–229PubMedGoogle Scholar
  3. 3.
    Bayston R (1971) Antibiotic prophylaxis in shunt therapy. Dev Med Child Neurol 17 [Suppl 35]: 99–103Google Scholar
  4. 4.
    Bayston R, Bannister C, Boston V, Burman R, Burns B, Cooke F, Cooke R, Cudmore R, Fitzgerald R, Goldberg C, Green HT, Guiney E, Hardwidge C, Hart CA, Holmes AE, Meigh J, Miles J, Rampling A, Walker J, Webb H, Whale K (1990) A prospective randomised controlled trial of antimicrobial prophylaxis in hydrocephalus shunt surgery. Z Kinderchir 45 [Suppl 1]: 5–7PubMedGoogle Scholar
  5. 5.
    Bayston R, Grove N, Siegel J, Lawellin D, Barsham S (1989) Prevention of hydrocephalus shunt catheter colonisation in vitro by impregnation with antimicrobials. J Neurol Neurosurg Psychiatry 52: 605–609PubMedGoogle Scholar
  6. 6.
    Blomstedt GC (1985) Results of trimethoprim-sulfamethoxazole prophylaxis in ventriculostomy and shunting procedures. J Neurosurg 62: 694–697PubMedGoogle Scholar
  7. 7.
    Blum J, Schwarz M, Voth D (1989) Antibiotic single-dose prophylaxis of shunt infections. Neurosurg Rev 12: 239–244PubMedGoogle Scholar
  8. 8.
    Choux M, Genitori L, Lang D, Lena G (1992) Shunt implantation: reducing the incidence of shunt infection. J Neurosurg 77: 875–880PubMedGoogle Scholar
  9. 9.
    Djindjian M, Fevrier MJ, Otterbein G, Soussy JC (1986) Oxacillin prophylaxis in cerebrospinal fluid shunt procedures: results of a randomized open study in 60 hydrocephalic patients. Surg Neurol 25: 178–180PubMedGoogle Scholar
  10. 10.
    Fokes EC (1970) Occult infections of ventriculoatrial shunts. J Neurosurg 33: 517–523PubMedGoogle Scholar
  11. 11.
    Forrest DM, Cooper DGW (1968) Complications of ventriculo-atrial shunts. J Neurosurg 29: 506–512Google Scholar
  12. 12.
    Forward KR, Fewer HD, Stiver HG (1983) Cerebrospinal fluid shunt infections. J Neurosurg 59: 389–394PubMedGoogle Scholar
  13. 13.
    Gardner B, Gordon DS (1982) Postoperative infection in shunts for hydrocephalus: are prophylactic antibiotics necessary. BMJ 284: 1914Google Scholar
  14. 14.
    Gardner P, Leipzig TJ, Phillips P (1985) Infections of central nervous system shunts. Med Clin North Am 69: 297–314PubMedGoogle Scholar
  15. 15.
    Gardner P, Leipzig TJ, Sadigh M (1988) Infections of mechanical cerebrospinal fluid shunts. Curr Clin Top Infect Dis 9: 185–214PubMedGoogle Scholar
  16. 16.
    George R, Leibrock L, Epstein M (1979) Extracranial CSF shunting for infantile non tumoral hydrocephalus — a retrospective analysis of 360 cases. Clin Neurol Neurosurg 81: 199–210PubMedGoogle Scholar
  17. 17.
    Giuffre R, Palma L, Fontana M (1979) Extracranial CSF shunting for infantile non tumoral hydrocephalus — a retrospective analysis of 360 cases. Clin Neurol Neurosurg 81: 199–210PubMedGoogle Scholar
  18. 18.
    Haines SJ, Taylor F (1982) Prophylactic methicillin for shunt operations: effects on the incidence of shunt malfunction and infection. Childs Brain 9: 10–22PubMedGoogle Scholar
  19. 19.
    Haines SJ, Walters BC (1994) Antibiotic prophylaxis for cerebrospinal fluid shunts: a metanalysis. Neurosurgery 34: 87–93PubMedGoogle Scholar
  20. 20.
    Hirsch J-F, Renier D, Pierre-Kahn A (1978) Influence of the use of a surgical isolator on the rate of infection in the treatment of hydrocephalus. Childs Brain 4: 137–150PubMedGoogle Scholar
  21. 21.
    Ignelzi RJ, Kirsch WM (1975) Follow-up analysis of ventriculoperitoneal and ventriculoatrial shunts for hydrocephalus. J Neurosurg 42: 679–682PubMedGoogle Scholar
  22. 22.
    Ivan LP, Choo SH, Ventueyra ECG (1980) Complications of ventriculoatrial and ventriculoperitoneal shunts in a New Children's Hospital. Can J Surg 23: 566–568PubMedGoogle Scholar
  23. 23.
    James HE, Walsh JW, Wilson HD, Connor JD, Bean JR, Tibbs PA (1980) Prospective randomized study of therapy in cerebrospinal fluid shunt infection. Neurosurg 7: 459–463Google Scholar
  24. 24.
    Kestle JR, Hoffman HJ, Soloniuk D, Humphreys RP, Drake JM, Hendrick EB (1993) A concerted effort to prevent shunt infection. Childs Nerv Syst 9: 163–165PubMedGoogle Scholar
  25. 25.
    Keucher TR, Mealey J (1979) Long-term results after ventriculoatrial and ventriculoperitoneal shunting for infantile hydrocephalus. J Neurosurg 50: 179–186PubMedGoogle Scholar
  26. 26.
    Lambert M, MacKinnon AE, Vaishnav A (1984) Comparison of two methods of prophylaxis against CSF shunt infection. Z Kinderchir 39 [Suppl II]: 109–110PubMedGoogle Scholar
  27. 27.
    Langley JM, LeBlanc JC, Drake J, Milner R (1993) Efficacy of antimicrobial prophylaxis in placement of cerebrospinal fluid shunts: Meta-analysis. Clin Inf Dis 17: 98–103Google Scholar
  28. 28.
    LeRoux P, Howard MA, Winn HR (1990) Vancomycin pharmacokinetics in hydrocephalic shunt prophylaxis and relationship to ventricular volume. Surg Neurol 34: 366–372PubMedGoogle Scholar
  29. 29.
    Lohmann G, Cardoso E, Pillalamari D, Gintautiene K, Chaudhury MR, Gintautas J, Abadir AR (1991) Prophylactic antibiotic shunt surgery. Proc West Pharmacol Soc 34: 353–354PubMedGoogle Scholar
  30. 30.
    Luthardt T (1970) Bacterial infections in ventriculo-auricular shunt systems. Dev Med Child Neurol 22: 105–109Google Scholar
  31. 31.
    Mazza C, Pasqualin A, Pian RD (1980) Results of treatment with ventriculoatrial and ventriculoperitoneal shunt in infantile nontumoral hydrocephalus. Childs Brain 7: 1–14PubMedGoogle Scholar
  32. 32.
    McCullough DC, Kane JG, Presper JH, Wells M (1980) Antibiotic prophylaxis in ventricular shunt surgery. Childs Brain 7: 182–189PubMedGoogle Scholar
  33. 33.
    Metzemaekers JDM, Becks JWF, Popta JSV (1987) Cerebrospinal fluid shunting for hydrocephalus: a retrospective analysis. Acta Neurochir (Wien) 88: 75–78Google Scholar
  34. 34.
    Morrice JJ, Young DG (1974) Bacterial colonisation of Holter valves: a ten-year survey. Dev Med Child Neurol 16 [Suppl 32]: 85–90Google Scholar
  35. 35.
    Odio C, McCracken GH, Nelson JD (1984) CSF shunt infections in pediatrics. A JDC 138: 1103–1108Google Scholar
  36. 36.
    O'Brien M, Parent A, Davis B (1979) Management of ventricular shunt infections. Childs Brain 5: 304–309PubMedGoogle Scholar
  37. 37.
    Pople IK, Bayston R, Hayward RD (1992) Infection of cerebrospinal fluid shunts in infants: a study of etiological factors. J Neurosurg 77: 29–36PubMedGoogle Scholar
  38. 38.
    Puca A, Anile C, Maire G, Rossi G (1991) Cerebrospinal fluid shunting for hydrocephalus in the adult: factors related to shunt revision. Neurosurgery 29: 822–826PubMedGoogle Scholar
  39. 39.
    Raimondi AJ, Robinson JS, Kuwaruma K (1977) Complications of ventriculoperitoneal shunting and a critical comparison of the three-piece and one-piece systems. Childs Brain 3: 321–342PubMedGoogle Scholar
  40. 40.
    Renier D, Lacombe J, Pierre-Kahn A, Sainte-Rose C, Hirsch J-F (1984) Factors causing acute shunt infection. Computer analysis of 1174 operations. J Neurosurg 61: 1072–1078PubMedGoogle Scholar
  41. 41.
    Rieder MJ, Frewen TC, Del Maestro RF, Coyle A, Lovell S (1987) The effect of cephalothin prophylaxis on postoperative ventriculoperitoneal shunt infections. CMAJ 136: 935–938PubMedGoogle Scholar
  42. 42.
    Salmon JH (1972) Adult hydrocephalus. Evaluation of shunt therapy in 80 patients. J Neurosurg 37: 423–428PubMedGoogle Scholar
  43. 43.
    Savitz MH, Mali LI, Meyers BR (1974) Prophylactic antibiotics in neurosurgery. Surg Neurol 2: 95–100PubMedGoogle Scholar
  44. 44.
    Sayers MP (1976) Shunt complications. Clin Neurosurg 23: 393–400PubMedGoogle Scholar
  45. 45.
    Scarff JE, Nelson PB, Reigel DH (1978) External drainage for ventricular infection following cerebrospinal fluid shunts. Childs Brain 4: 129–136PubMedGoogle Scholar
  46. 46.
    Schmidt K, Gjerris F, Osgaard O, Hvidberg EF, Kristiansen JE, Dahlerup B, Kruse-Larsen C (1985) Antibiotic prophylaxis in cerebrospinal fluid shunting. A prospective randomized trial in 152 hydrocephalic children. Neurosurgery 17: 1–5PubMedGoogle Scholar
  47. 47.
    Schoenbaum SC, Gardner P, Shillito J (1975) Infections of cerebrospinal fluid shunts: epidemiology, clinical manifestations, and therapy. J Infect Dis 131: 543–552PubMedGoogle Scholar
  48. 48.
    Shapiro M, Wald U, Simchen E, Pomeranz S, Zagzaf D, Michowiz SD, Samuel-Cahn E, Wax Y, Shuval R, Kahane Y, Sacks T, Shalit M (1986) Randomized clinical trial of intraoperative antimicrobial prophylaxis of infection after neurosurgical procedures. J Hosp Infect 8: 283–295PubMedGoogle Scholar
  49. 49.
    Shapiro S, Boaz J, Kleiman M, Kalsbeck J, Mealey J (1988) Origin of organisms infecting ventricular shunts. Neurosurgery 22: 868–872PubMedGoogle Scholar
  50. 50.
    Strømblad L-G, Schalèn C, Steen A, Sundbarg G, Kamme C (1987) Bacterial contamination in cerebrospinal fluid shunt surgery. Scand J Infect Dis 19: 211–214PubMedGoogle Scholar
  51. 51.
    Tabara Z, Forrest D (1982) Colonisation of CSF shunts: preventive measures. Z Kinderchir 37: 156–157Google Scholar
  52. 52.
    Venes JL (1976) Control of shunt infection. J Neurosurg 45: 311–314PubMedGoogle Scholar
  53. 53.
    Walters BC, Hoffman HJ, Hendrick EB, Humphreys RP (1984) Cerebrospinal fluid shunt infection. J Neurosurg 60: 1014–1021PubMedGoogle Scholar
  54. 54.
    Walters BC, Hoffmann HJ (1985) Decreased risk of infection in cerebrospinal fluid shunt surgery using prophylactic antibiotics: a case-control study. Z Kinderchir 40 [Suppl I]: 15–18PubMedGoogle Scholar
  55. 55.
    Weiss SR, Raskind R (1970) Further experience with the ventriculoperitoneal shunt. Int Surg 53: 300–303PubMedGoogle Scholar
  56. 56.
    Yogev R, Davis AD (1980) Neurosurgical shunt infections. Childs Brain 6: 74–81PubMedGoogle Scholar
  57. 57.
    Yu HC, Patterson RH (1973) Prophylactic antimicrobial agents after ventriculoatriostomy for hydrocephalus. J Pediatr Surg 8: 881–885PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1995

Authors and Affiliations

  • B. M. Borgbjerg
    • 1
  • F. Gjerris
    • 1
  • M. J. Albeck
    • 1
  • S. E. Børgesen
    • 1
  1. 1.The University Clinic of NeurosurgeryRigshospitaletDenmark

Personalised recommendations