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Towards zero infection for ventriculoperitoneal shunt insertion in resource-limited settings: a multicenter prospective cohort study

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Abstract

Introduction

Shunting for hydrocephalus can lead to improvement in the quality of life although the latter has been subdued by complications like shunt infection. Established protocols have contributed to the reduction of ventriculoperitoneal shunt (VPS) infections. Previously, we retrospectively demonstrated a low infection rate despite some of the protocol recommendations not being implemented. The aim of this study was to prospectively establish the incidence of shunt infection in the early post-shunt period following our protocol and elucidate on associated risk factors.

Patients and methods

A multicenter prospective descriptive cohort study of consecutive 209 under-5 children requiring VPS for hydrocephalus was conducted between January 2013 and November 2018. An innovative protocol insisting on intermittent application of povidone-iodine on the skin during the operation was implemented. The patients were followed-up for 3 months post-surgery.

Results

Included were 211 VPS procedures performed on 209 children. The median age was 9 months and 84 were males. Hydrocephalus was non-communicative in 72.0% and aqueductal stenosis was its most frequent cause (84.9%). Most surgeries were performed in the morning (90.5%), electively (95.3%), and for the first time (91%). The median duration of surgery was 65 min. Shunt infection rate was 1.9% (n = 4) (95% CI 0.7 to 5.0%) per procedure.

Conclusion

The observed infection rate was low. This suggests that the protocol followed captured the most critical components necessary to ensure low infection rates and that simple measures implemented in economically challenged environments may achieve internationally acceptable infection rates.

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Abbreviations

CSF:

Cerebrospinal fluid

VPS:

Ventriculoperitoneal shunt

ETV:

Endoscopic third ventriculostomy

EVD:

External ventricular drainage

HCP:

Hydrocephalus

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Author information

Authors and Affiliations

  1. Neurosurgery Division, Department of Surgery, University Of Zimbabwe, Harare, Zimbabwe

    Kazadi K. N. Kalangu, Maximillian Dzowa & Aaron Musara

  2. Neurosurgery Division, Department of Surgery, University Of Bamenda, Bamenda, Cameroon

    Ignatius N. Esene

  3. Department of Neurosurgery, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo

    Jeff Ntalaja

  4. Neurosurgical Unit, Medipark/Oshakati Hospital, University of Namibia, Windhoek, Namibia

    Aliou K. Badra

Authors
  1. Kazadi K. N. Kalangu
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  2. Ignatius N. Esene
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  3. Maximillian Dzowa
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  4. Aaron Musara
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  5. Jeff Ntalaja
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  6. Aliou K. Badra
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Correspondence to Kazadi K. N. Kalangu.

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Kalangu, K.K.N., Esene, I.N., Dzowa, M. et al. Towards zero infection for ventriculoperitoneal shunt insertion in resource-limited settings: a multicenter prospective cohort study. Childs Nerv Syst 36, 401–409 (2020). https://doi.org/10.1007/s00381-019-04357-z

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