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.
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Ajir F, Levin AB, Duff TA (1981) Effect of prophylactic methicillin on cerebrospinal fluid shunt infections in children. Neurosurgery 9: 6–9
Amacher AL, Wellington J (1984) Infantile hydrocephalus: long-term results of surgical therapy. Childs Brain 11: 217–229
Bayston R (1971) Antibiotic prophylaxis in shunt therapy. Dev Med Child Neurol 17 [Suppl 35]: 99–103
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]: 5–7
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: 605–609
Blomstedt GC (1985) Results of trimethoprim-sulfamethoxazole prophylaxis in ventriculostomy and shunting procedures. J Neurosurg 62: 694–697
Blum J, Schwarz M, Voth D (1989) Antibiotic single-dose prophylaxis of shunt infections. Neurosurg Rev 12: 239–244
Choux M, Genitori L, Lang D, Lena G (1992) Shunt implantation: reducing the incidence of shunt infection. J Neurosurg 77: 875–880
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: 178–180
Fokes EC (1970) Occult infections of ventriculoatrial shunts. J Neurosurg 33: 517–523
Forrest DM, Cooper DGW (1968) Complications of ventriculo-atrial shunts. J Neurosurg 29: 506–512
Forward KR, Fewer HD, Stiver HG (1983) Cerebrospinal fluid shunt infections. J Neurosurg 59: 389–394
Gardner B, Gordon DS (1982) Postoperative infection in shunts for hydrocephalus: are prophylactic antibiotics necessary. BMJ 284: 1914
Gardner P, Leipzig TJ, Phillips P (1985) Infections of central nervous system shunts. Med Clin North Am 69: 297–314
Gardner P, Leipzig TJ, Sadigh M (1988) Infections of mechanical cerebrospinal fluid shunts. Curr Clin Top Infect Dis 9: 185–214
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: 199–210
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: 199–210
Haines SJ, Taylor F (1982) Prophylactic methicillin for shunt operations: effects on the incidence of shunt malfunction and infection. Childs Brain 9: 10–22
Haines SJ, Walters BC (1994) Antibiotic prophylaxis for cerebrospinal fluid shunts: a metanalysis. Neurosurgery 34: 87–93
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: 137–150
Ignelzi RJ, Kirsch WM (1975) Follow-up analysis of ventriculoperitoneal and ventriculoatrial shunts for hydrocephalus. J Neurosurg 42: 679–682
Ivan LP, Choo SH, Ventueyra ECG (1980) Complications of ventriculoatrial and ventriculoperitoneal shunts in a New Children's Hospital. Can J Surg 23: 566–568
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: 459–463
Kestle JR, Hoffman HJ, Soloniuk D, Humphreys RP, Drake JM, Hendrick EB (1993) A concerted effort to prevent shunt infection. Childs Nerv Syst 9: 163–165
Keucher TR, Mealey J (1979) Long-term results after ventriculoatrial and ventriculoperitoneal shunting for infantile hydrocephalus. J Neurosurg 50: 179–186
Lambert M, MacKinnon AE, Vaishnav A (1984) Comparison of two methods of prophylaxis against CSF shunt infection. Z Kinderchir 39 [Suppl II]: 109–110
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: 98–103
LeRoux P, Howard MA, Winn HR (1990) Vancomycin pharmacokinetics in hydrocephalic shunt prophylaxis and relationship to ventricular volume. Surg Neurol 34: 366–372
Lohmann G, Cardoso E, Pillalamari D, Gintautiene K, Chaudhury MR, Gintautas J, Abadir AR (1991) Prophylactic antibiotic shunt surgery. Proc West Pharmacol Soc 34: 353–354
Luthardt T (1970) Bacterial infections in ventriculo-auricular shunt systems. Dev Med Child Neurol 22: 105–109
Mazza C, Pasqualin A, Pian RD (1980) Results of treatment with ventriculoatrial and ventriculoperitoneal shunt in infantile nontumoral hydrocephalus. Childs Brain 7: 1–14
McCullough DC, Kane JG, Presper JH, Wells M (1980) Antibiotic prophylaxis in ventricular shunt surgery. Childs Brain 7: 182–189
Metzemaekers JDM, Becks JWF, Popta JSV (1987) Cerebrospinal fluid shunting for hydrocephalus: a retrospective analysis. Acta Neurochir (Wien) 88: 75–78
Morrice JJ, Young DG (1974) Bacterial colonisation of Holter valves: a ten-year survey. Dev Med Child Neurol 16 [Suppl 32]: 85–90
Odio C, McCracken GH, Nelson JD (1984) CSF shunt infections in pediatrics. A JDC 138: 1103–1108
O'Brien M, Parent A, Davis B (1979) Management of ventricular shunt infections. Childs Brain 5: 304–309
Pople IK, Bayston R, Hayward RD (1992) Infection of cerebrospinal fluid shunts in infants: a study of etiological factors. J Neurosurg 77: 29–36
Puca A, Anile C, Maire G, Rossi G (1991) Cerebrospinal fluid shunting for hydrocephalus in the adult: factors related to shunt revision. Neurosurgery 29: 822–826
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: 321–342
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: 1072–1078
Rieder MJ, Frewen TC, Del Maestro RF, Coyle A, Lovell S (1987) The effect of cephalothin prophylaxis on postoperative ventriculoperitoneal shunt infections. CMAJ 136: 935–938
Salmon JH (1972) Adult hydrocephalus. Evaluation of shunt therapy in 80 patients. J Neurosurg 37: 423–428
Savitz MH, Mali LI, Meyers BR (1974) Prophylactic antibiotics in neurosurgery. Surg Neurol 2: 95–100
Sayers MP (1976) Shunt complications. Clin Neurosurg 23: 393–400
Scarff JE, Nelson PB, Reigel DH (1978) External drainage for ventricular infection following cerebrospinal fluid shunts. Childs Brain 4: 129–136
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: 1–5
Schoenbaum SC, Gardner P, Shillito J (1975) Infections of cerebrospinal fluid shunts: epidemiology, clinical manifestations, and therapy. J Infect Dis 131: 543–552
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: 283–295
Shapiro S, Boaz J, Kleiman M, Kalsbeck J, Mealey J (1988) Origin of organisms infecting ventricular shunts. Neurosurgery 22: 868–872
Strømblad L-G, Schalèn C, Steen A, Sundbarg G, Kamme C (1987) Bacterial contamination in cerebrospinal fluid shunt surgery. Scand J Infect Dis 19: 211–214
Tabara Z, Forrest D (1982) Colonisation of CSF shunts: preventive measures. Z Kinderchir 37: 156–157
Venes JL (1976) Control of shunt infection. J Neurosurg 45: 311–314
Walters BC, Hoffman HJ, Hendrick EB, Humphreys RP (1984) Cerebrospinal fluid shunt infection. J Neurosurg 60: 1014–1021
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]: 15–18
Weiss SR, Raskind R (1970) Further experience with the ventriculoperitoneal shunt. Int Surg 53: 300–303
Yogev R, Davis AD (1980) Neurosurgical shunt infections. Childs Brain 6: 74–81
Yu HC, Patterson RH (1973) Prophylactic antimicrobial agents after ventriculoatriostomy for hydrocephalus. J Pediatr Surg 8: 881–885
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Borgbjerg, B.M., Gjerris, F., Albeck, M.J. et al. Risk of infection after cerebrospinal fluid shunt: An analysis of 884 first-time shunts. Acta neurochir 136, 1–7 (1995). https://doi.org/10.1007/BF01411427
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DOI: https://doi.org/10.1007/BF01411427