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Global trends in the evaluation and management of cerebrospinal fluid shunt infection: a cooperative ISPN survey

Child's Nervous System volume 36, pages 2949–2960 (2020)Cite this article

Abstract

Introduction

Ventriculoperitoneal shunts (VPS) is commonly performed by pediatric neurosurgeons and there is no consensus in management of VPS infection as it relates to diagnosis and treatment.

Objective

We utilized an international practitioner-based survey to study the variability in VPS infection diagnostic and therapeutic measures.

Methods

A survey gauging practice patterns of pediatric neurosurgeons regarding VPS and its complication management was distributed. Survey endpoints were analyzed by VPS case volume and pediatric-focused case volume regarding diagnostic measures, use of cerebrospinal fluid (CSF) profile, microbiology, and treatment.

Results

A total of 439 surveys were distributed, with a response rate of 31%. Responders ranged from Americas (44.9%), European (31.4%), Asian (18.6%), African (2.5%), to Australian continents (2.5%). Practitioners were stratified based on number and percentage pediatric VPS performed. Institutions performing highest VPS and percentage pediatric case volumes had lower rate of VPS infection. Shunt tap was the most widely used diagnostic study. Overall CSF profile did not affect decision making towards VPS internalization, except for leukocyte count ≤ 20 × 109/L. Practitioners utilized 3 negative cultures prior to VPS internalization. Discrepancies in surgical management were noted amongst centers with high versus low VPS volume and proportion of pediatric-focused case volume. Practice patterns were not noted to be organism dependent. Antibiotic-impregnated shunts were utilized in the Americas and Europe over other regions but only in one third of all initial VPS or as a preventive strategy after a VPS infection has been resolved respectively.

Discussion

Survey results from 6 continents in VPS management revealed patterns of lower infection in high-volume centers, 3 negative cultures prior to internalization and aggressive surgical VPS infection management in high-volume institutions.

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Abbreviations

AIS:

Antibiotic-coated shunt

CSF:

Cerebrospinal fluid

EVD:

External ventricular drain

ISPN:

International Society for Pediatric Neurosurgery

LP:

Lumbar puncture

ST:

Shunt tap

VPS:

Ventriculoperitoneal shunt

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Author information

Affiliations

  1. Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA

    Mandana Behbahani

  2. Rush University Medical Center, Chicago, IL, USA

    Syed I. Khalid

  3. Division of Pediatric Neurosurgery, Ann and Robert H Lurie Children´s Hospital, Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Sandi K. Lam

  4. Department of Neurosurgery, National Children’s Hospital of Costa Rica, “Dr. Carlos Saenz Herrera”, San José, Costa Rica

    Adrian Caceres

Authors
  1. Mandana Behbahani
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  2. Syed I. Khalid
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  3. Sandi K. Lam
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  4. Adrian Caceres
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Contributions

Conception and design: Dr. Adrián Cáceres.

Acquisition of data: Dr. Adrián Cáceres.

Analysis and interpretation of data: Dr. Adrián Cáceres, Dr. Sandi K. Lam, Dr. Syed Khalid, Dr. Mandana Behbahani.

Drafting of the article: Dr. Adrián Cáceres, Dr. Sandi K. Lam, Dr. Syed Khalid, Dr. Mandana Behbahani.

Critically revising the article: Dr. Adrián Cáceres, Dr. Sandi K. Lam.

Reviewed submitted version of the article: Dr. Adrián Cáceres, Dr. Sandi K. Lam.

Approved the final version of the manuscript on behalf of all authors: Dr. Adrián Cáceres.

Statistical analysis: Dr. Syed Khalid, Dr. Mandana Behbahani.

Study supervision: Dr. Adrián Cáceres.

Corresponding author

Correspondence to Adrian Caceres.

Ethics declarations

The study was approved by the National Children’s Hospital of Costa Rica Institutional Review Board with a waiver of patient informed consent, as the nature of this analysis posed minimal risk to participating individuals, and the data was presented in aggregate to minimize any risks. Completion of the survey implied consent to participate.

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None.

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Behbahani, M., Khalid, S.I., Lam, S.K. et al. Global trends in the evaluation and management of cerebrospinal fluid shunt infection: a cooperative ISPN survey. Childs Nerv Syst 36, 2949–2960 (2020). https://doi.org/10.1007/s00381-020-04699-z

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  • DOI: https://doi.org/10.1007/s00381-020-04699-z

Keywords

  • Ventriculoperitoneal shunt infection
  • VPS
  • EVD
  • Antibiotic-impregnated catheter