Skip to main content
Erschienen in: Child's Nervous System 4/2015

01.04.2015 | Original Paper

Evidence-based interventions to reduce shunt infections: a systematic review

verfasst von: Nehaw Sarmey, Varun R. Kshettry, Michael F. Shriver, Ghaith Habboub, Andre G. Machado, Robert J. Weil

Erschienen in: Child's Nervous System | Ausgabe 4/2015

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Cerebrospinal fluid shunt infection is associated with patient morbidity and high cost. We conducted a systematic review of the current evidence of comprehensive surgical protocols or individual interventions designed to reduce shunt infection incidence.

Methods

A systematic review using PubMed and SCOPUS identified studies evaluating the effect of a particular intervention on shunt infection risk. Systemic prophylactic antibiotic or antibiotic-impregnated shunt efficacy studies were excluded. A total of 7429 articles were screened and 23 articles were included.

Results

Eight studies evaluated the effect of comprehensive surgical protocols. Shunt infection was reduced in all studies (absolute risk reduction 2.2–12.3 %). Level of evidence was low (level 4 in seven studies) due to the use of historical controls. Compliance ranged from 24.6 to 74.5 %. Surgical scrub with antiseptic foam and omission of a 5 % chlorhexidine gluconate preoperative hair wash were both associated with increased shunt infection. Twelve studies evaluated the effect of a single intervention. Only antibiotic-impregnated suture, a no-shave policy, and double gloving with glove change prior to shunt handling, were associated with a significant reduction in shunt infection. In a hospital with high methicillin-resistant staphylococcus aureus (MRSA) prevalence, a randomized controlled trial found that perioperative vancomycin rather than cefazolin significantly reduced shunt infection rates.

Conclusion

Despite wide variation in compliance rates, the implementation of comprehensive surgical protocols reduced shunt infection in all published studies. Antibiotic-impregnated suture, a no-shave policy, double gloving with glove change prior to device manipulation, and 5 % chlorhexidine hair wash were associated with significant reductions in shunt infection.
Literatur
1.
Zurück zum Zitat Bondurant CP, Jimenez DF (1995) Epidemiology of cerebrospinal fluid shunting. Pediatr Neurosurg 23:254–258CrossRefPubMed Bondurant CP, Jimenez DF (1995) Epidemiology of cerebrospinal fluid shunting. Pediatr Neurosurg 23:254–258CrossRefPubMed
2.
Zurück zum Zitat Patwardhan RV, Nanda A (2005) Implanted ventricular shunts in the United States: the billion-dollar-a-year cost of hydrocephalus treatment. Neurosurgery 56:139–145PubMed Patwardhan RV, Nanda A (2005) Implanted ventricular shunts in the United States: the billion-dollar-a-year cost of hydrocephalus treatment. Neurosurgery 56:139–145PubMed
3.
Zurück zum Zitat Simon TD, Riva-Cambrin J, Srivastava R, Bratton SL, Dean JM, Kestle JRW, Hydrocephalus Clinical Research Network (2008) Hospital care for children with hydrocephalus in the United States: utilization, charges, comorbidities, and deaths. J Neurosurg Pediatr 1:131–137CrossRefPubMed Simon TD, Riva-Cambrin J, Srivastava R, Bratton SL, Dean JM, Kestle JRW, Hydrocephalus Clinical Research Network (2008) Hospital care for children with hydrocephalus in the United States: utilization, charges, comorbidities, and deaths. J Neurosurg Pediatr 1:131–137CrossRefPubMed
4.
Zurück zum Zitat Browd SR, Ragel BT, Gottfried ON, Kestle JRW (2006) Failure of cerebrospinal fluid shunts: part i: obstruction and mechanical failure. Pediatr Neurol 34:83–92CrossRefPubMed Browd SR, Ragel BT, Gottfried ON, Kestle JRW (2006) Failure of cerebrospinal fluid shunts: part i: obstruction and mechanical failure. Pediatr Neurol 34:83–92CrossRefPubMed
5.
Zurück zum Zitat Duhaime A-C (2006) Evaluation and management of shunt infections in children with hydrocephalus. Clin Pediatr (Phila) 45:705–713CrossRef Duhaime A-C (2006) Evaluation and management of shunt infections in children with hydrocephalus. Clin Pediatr (Phila) 45:705–713CrossRef
6.
Zurück zum Zitat Simon TD, Hall M, Riva-Cambrin J, Albert JE, Jeffries HE, LaFleur B, Dean JM, Kestle JR, Hydrocephalus Clinical Research Network (2009) Infection rates following initial cerebrospinal fluid shunt placement across pediatric hospitals in the United States. J Neurosurg Pediatr 4:156–165CrossRefPubMedCentralPubMed Simon TD, Hall M, Riva-Cambrin J, Albert JE, Jeffries HE, LaFleur B, Dean JM, Kestle JR, Hydrocephalus Clinical Research Network (2009) Infection rates following initial cerebrospinal fluid shunt placement across pediatric hospitals in the United States. J Neurosurg Pediatr 4:156–165CrossRefPubMedCentralPubMed
7.
Zurück zum Zitat Reddy GK, Bollam P, Caldito G (2012) Ventriculoperitoneal shunt surgery and the risk of shunt infection in patients with hydrocephalus: long-term single institution experience. World Neurosurg 78:155–163CrossRefPubMed Reddy GK, Bollam P, Caldito G (2012) Ventriculoperitoneal shunt surgery and the risk of shunt infection in patients with hydrocephalus: long-term single institution experience. World Neurosurg 78:155–163CrossRefPubMed
8.
Zurück zum Zitat Jeelani NU O, Kulkarni AV, DeSilva P, Thompson DNP, Hayward RD (2009) Postoperative cerebrospinal fluid wound leakage as a predictor of shunt infection: a prospective analysis of 205 cases. J Neurosurg Pediatr 4:166–169CrossRefPubMed Jeelani NU O, Kulkarni AV, DeSilva P, Thompson DNP, Hayward RD (2009) Postoperative cerebrospinal fluid wound leakage as a predictor of shunt infection: a prospective analysis of 205 cases. J Neurosurg Pediatr 4:166–169CrossRefPubMed
9.
Zurück zum Zitat McGirt MJ, Zaas A, Fuchs HE, George TM, Kaye K, Sexton DJ (2003) Risk factors for pediatric ventriculoperitoneal shunt infection and predictors of infectious pathogens. Clin Infect Dis 36:858–862CrossRefPubMed McGirt MJ, Zaas A, Fuchs HE, George TM, Kaye K, Sexton DJ (2003) Risk factors for pediatric ventriculoperitoneal shunt infection and predictors of infectious pathogens. Clin Infect Dis 36:858–862CrossRefPubMed
10.
Zurück zum Zitat Shannon CN, Simon TD, Reed GT, Franklin FA, Kirby RS, Kilgore ML, Wellons JC 3rd (2011) The economic impact of ventriculoperitoneal shunt failure. J Neurosurg Pediatr 8:593–599CrossRefPubMedCentralPubMed Shannon CN, Simon TD, Reed GT, Franklin FA, Kirby RS, Kilgore ML, Wellons JC 3rd (2011) The economic impact of ventriculoperitoneal shunt failure. J Neurosurg Pediatr 8:593–599CrossRefPubMedCentralPubMed
11.
Zurück zum Zitat Attenello FJ, Garces-Ambrossi GL, Zaidi HA, Sciubba DM, Jallo GI (2010) Hospital costs associated with shunt infections in patients receiving antibiotic-impregnated shunt catheters versus standard shunt catheters. Neurosurgery 66:284–289CrossRefPubMed Attenello FJ, Garces-Ambrossi GL, Zaidi HA, Sciubba DM, Jallo GI (2010) Hospital costs associated with shunt infections in patients receiving antibiotic-impregnated shunt catheters versus standard shunt catheters. Neurosurgery 66:284–289CrossRefPubMed
12.
Zurück zum Zitat Ratilal B, Costa J, Sampaio C (2006) Antibiotic prophylaxis for surgical introduction of intracranial ventricular shunts. Cochrane Database Syst Rev CD005365 Ratilal B, Costa J, Sampaio C (2006) Antibiotic prophylaxis for surgical introduction of intracranial ventricular shunts. Cochrane Database Syst Rev CD005365
13.
Zurück zum Zitat Parker SL, Anderson WN, Lilienfeld S, Megerian JT, McGirt MJ (2011) Cerebrospinal shunt infection in patients receiving antibiotic-impregnated versus standard shunts. J Neurosurg Pediatr 8:259–265CrossRefPubMed Parker SL, Anderson WN, Lilienfeld S, Megerian JT, McGirt MJ (2011) Cerebrospinal shunt infection in patients receiving antibiotic-impregnated versus standard shunts. J Neurosurg Pediatr 8:259–265CrossRefPubMed
14.
Zurück zum Zitat Eymann R, Chehab S, Strowitzki M, Steudel W-I, Kiefer M (2008) Clinical and economic consequences of antibiotic-impregnated cerebrospinal fluid shunt catheters. J Neurosurg Pediatr 1:444–450CrossRefPubMed Eymann R, Chehab S, Strowitzki M, Steudel W-I, Kiefer M (2008) Clinical and economic consequences of antibiotic-impregnated cerebrospinal fluid shunt catheters. J Neurosurg Pediatr 1:444–450CrossRefPubMed
15.
Zurück zum Zitat Klimo P Jr, Thompson CJ, Ragel BT, Boop FA (2011) Antibiotic-impregnated shunt systems versus standard shunt systems: a meta- and cost-savings analysis. J Neurosurg Pediatr 8:600–612CrossRefPubMed Klimo P Jr, Thompson CJ, Ragel BT, Boop FA (2011) Antibiotic-impregnated shunt systems versus standard shunt systems: a meta- and cost-savings analysis. J Neurosurg Pediatr 8:600–612CrossRefPubMed
16.
Zurück zum Zitat Richards HK, Seeley HM, Pickard JD (2009) Efficacy of antibiotic-impregnated shunt catheters in reducing shunt infection: data from the United Kingdom Shunt Registry. J Neurosurg Pediatr 4:389–393CrossRefPubMed Richards HK, Seeley HM, Pickard JD (2009) Efficacy of antibiotic-impregnated shunt catheters in reducing shunt infection: data from the United Kingdom Shunt Registry. J Neurosurg Pediatr 4:389–393CrossRefPubMed
17.
Zurück zum Zitat Thomas R, Lee S, Patole S, Rao S (2012) Antibiotic-impregnated catheters for the prevention of CSF shunt infections: a systematic review and meta-analysis. Br J Neurosurg 26:175–184CrossRefPubMed Thomas R, Lee S, Patole S, Rao S (2012) Antibiotic-impregnated catheters for the prevention of CSF shunt infections: a systematic review and meta-analysis. Br J Neurosurg 26:175–184CrossRefPubMed
18.
Zurück zum Zitat Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. PLoS Med 6:e1000097CrossRefPubMedCentralPubMed Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. PLoS Med 6:e1000097CrossRefPubMedCentralPubMed
19.
Zurück zum Zitat Howick J, Chalmers I, Glasziou P, Greenhalgh T, Heneghan C, Liberati A, Moschetti I, Phillips B, Thornton H (2011) Explanation of the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence (Background Document). Oxf Cent Evid-Based Med. http://www.cebm.net/index.aspx?o=5653 Howick J, Chalmers I, Glasziou P, Greenhalgh T, Heneghan C, Liberati A, Moschetti I, Phillips B, Thornton H (2011) Explanation of the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence (Background Document). Oxf Cent Evid-Based Med. http://​www.​cebm.​net/​index.​aspx?​o=​5653
20.
Zurück zum Zitat Hommelstad J, Madsø A, Eide PK (2013) Significant reduction of shunt infection rate in children below 1 year of age after implementation of a perioperative protocol. Acta Neurochir (Wien) 155:523–531CrossRef Hommelstad J, Madsø A, Eide PK (2013) Significant reduction of shunt infection rate in children below 1 year of age after implementation of a perioperative protocol. Acta Neurochir (Wien) 155:523–531CrossRef
21.
Zurück zum Zitat Kestle JR, Hoffman HJ, Soloniuk D, Humphreys RP, Drake JM, Hendrick EB (1993) A concerted effort to prevent shunt infection. Childs Nerv Syst 9:163–165PubMed Kestle JR, Hoffman HJ, Soloniuk D, Humphreys RP, Drake JM, Hendrick EB (1993) A concerted effort to prevent shunt infection. Childs Nerv Syst 9:163–165PubMed
22.
Zurück zum Zitat Pirotte BJM, Lubansu A, Bruneau M, Loqa C, Van Cutsem N, Brotchi J (2007) Sterile surgical technique for shunt placement reduces the shunt infection rate in children: preliminary analysis of a prospective protocol in 115 consecutive procedures. Childs Nerv Syst 23:1251–1261CrossRefPubMed Pirotte BJM, Lubansu A, Bruneau M, Loqa C, Van Cutsem N, Brotchi J (2007) Sterile surgical technique for shunt placement reduces the shunt infection rate in children: preliminary analysis of a prospective protocol in 115 consecutive procedures. Childs Nerv Syst 23:1251–1261CrossRefPubMed
23.
Zurück zum Zitat Mottolese C, Grando J, Convert J, Abdoulrahman M, Lelievre H, Vandenesch F, Bret P, Lapras C (2000) Zero rate of shunt infection in the first postoperative year in children–dream or reality? Childs Nerv Syst 16:210–212CrossRefPubMed Mottolese C, Grando J, Convert J, Abdoulrahman M, Lelievre H, Vandenesch F, Bret P, Lapras C (2000) Zero rate of shunt infection in the first postoperative year in children–dream or reality? Childs Nerv Syst 16:210–212CrossRefPubMed
24.
Zurück zum Zitat Rotim K, Miklic P, Paladino J, Melada A, Marcikic M, Scap M (1997) Reducing the incidence of infection in pediatric cerebrospinal fluid shunt operations. Childs Nerv Syst 13:584–587CrossRefPubMed Rotim K, Miklic P, Paladino J, Melada A, Marcikic M, Scap M (1997) Reducing the incidence of infection in pediatric cerebrospinal fluid shunt operations. Childs Nerv Syst 13:584–587CrossRefPubMed
25.
Zurück zum Zitat Kestle JRW, Riva-Cambrin J, Wellons JC 3rd, Kulkarni AV, Whitehead WE, Walker ML, Oakes WJ, Drake JM, Luerssen TG, Simon TD, Holubkov R, Hydrocephalus Clinical Research Network (2011) A standardized protocol to reduce cerebrospinal fluid shunt infection: the Hydrocephalus Clinical Research Network Quality Improvement Initiative. J Neurosurg Pediatr 8:22–29CrossRefPubMedCentralPubMed Kestle JRW, Riva-Cambrin J, Wellons JC 3rd, Kulkarni AV, Whitehead WE, Walker ML, Oakes WJ, Drake JM, Luerssen TG, Simon TD, Holubkov R, Hydrocephalus Clinical Research Network (2011) A standardized protocol to reduce cerebrospinal fluid shunt infection: the Hydrocephalus Clinical Research Network Quality Improvement Initiative. J Neurosurg Pediatr 8:22–29CrossRefPubMedCentralPubMed
26.
Zurück zum Zitat Choux M, Genitori L, Lang D, Lena G (1992) Shunt implantation: reducing the incidence of shunt infection. J Neurosurg 77:875–880CrossRefPubMed Choux M, Genitori L, Lang D, Lena G (1992) Shunt implantation: reducing the incidence of shunt infection. J Neurosurg 77:875–880CrossRefPubMed
27.
Zurück zum Zitat Welch K (1979) Residual shunt infection in a program aimed at its prevention. Z Kinderchir Grenzgeb 28:374–377PubMed Welch K (1979) Residual shunt infection in a program aimed at its prevention. Z Kinderchir Grenzgeb 28:374–377PubMed
28.
Zurück zum Zitat Haliasos N, Bhatia R, Hartley J, Thompson D (2012) Ioban drapes against shunt infections? Childs Nerv Syst 28:509–510CrossRefPubMed Haliasos N, Bhatia R, Hartley J, Thompson D (2012) Ioban drapes against shunt infections? Childs Nerv Syst 28:509–510CrossRefPubMed
29.
Zurück zum Zitat Theophilus SC, Adnan JS (2011) A randomised control trial on the use of topical methicillin in reducing post-operative ventriculoperitoneal shunt infection. Malays J Med Sci 18:30–37PubMedCentralPubMed Theophilus SC, Adnan JS (2011) A randomised control trial on the use of topical methicillin in reducing post-operative ventriculoperitoneal shunt infection. Malays J Med Sci 18:30–37PubMedCentralPubMed
30.
Zurück zum Zitat Hayashi T, Shirane R, Yokosawa M, Kimiwada T, Tominaga T (2010) Efficacy of intraoperative irrigation with saline for preventing shunt infection. J Neurosurg Pediatr 6:273–276CrossRefPubMed Hayashi T, Shirane R, Yokosawa M, Kimiwada T, Tominaga T (2010) Efficacy of intraoperative irrigation with saline for preventing shunt infection. J Neurosurg Pediatr 6:273–276CrossRefPubMed
31.
Zurück zum Zitat Rehman A-U, Rehman T-U, Bashir HH, Gupta V (2010) A simple method to reduce infection of ventriculoperitoneal shunts. J Neurosurg Pediatr 5:569–572CrossRefPubMed Rehman A-U, Rehman T-U, Bashir HH, Gupta V (2010) A simple method to reduce infection of ventriculoperitoneal shunts. J Neurosurg Pediatr 5:569–572CrossRefPubMed
32.
Zurück zum Zitat Eymann R, Kiefer M (2010) Glue instead of stitches: a minor change of the operative technique with a serious impact on the shunt infection rate. Acta Neurochir Suppl 106:87–89CrossRefPubMed Eymann R, Kiefer M (2010) Glue instead of stitches: a minor change of the operative technique with a serious impact on the shunt infection rate. Acta Neurochir Suppl 106:87–89CrossRefPubMed
33.
Zurück zum Zitat Rozzelle CJ, Leonardo J, Li V (2008) Antimicrobial suture wound closure for cerebrospinal fluid shunt surgery: a prospective, double-blinded, randomized controlled trial. J Neurosurg Pediatr 2:111–117CrossRefPubMed Rozzelle CJ, Leonardo J, Li V (2008) Antimicrobial suture wound closure for cerebrospinal fluid shunt surgery: a prospective, double-blinded, randomized controlled trial. J Neurosurg Pediatr 2:111–117CrossRefPubMed
34.
Zurück zum Zitat Nejat F, Tajik P, El Khashab M, Kazmi SS, Khotaei GT, Salahesh S (2008) A randomized trial of ceftriaxone versus trimethoprim-sulfamethoxazole to prevent ventriculoperitoneal shunt infection. J Microbiol Immunol Infect 41:112–117PubMed Nejat F, Tajik P, El Khashab M, Kazmi SS, Khotaei GT, Salahesh S (2008) A randomized trial of ceftriaxone versus trimethoprim-sulfamethoxazole to prevent ventriculoperitoneal shunt infection. J Microbiol Immunol Infect 41:112–117PubMed
35.
Zurück zum Zitat Tulipan N, Cleves MA (2006) Effect of an intraoperative double-gloving strategy on the incidence of cerebrospinal fluid shunt infection. J Neurosurg 104:5–8PubMed Tulipan N, Cleves MA (2006) Effect of an intraoperative double-gloving strategy on the incidence of cerebrospinal fluid shunt infection. J Neurosurg 104:5–8PubMed
36.
Zurück zum Zitat Ratanalert S, Musikawat P, Oearsakul T, Saeheng S, Chowchuvech V (2005) Non-shaved ventriculoperitoneal shunt in Thailand. J Clin Neurosci 12:147–149CrossRefPubMed Ratanalert S, Musikawat P, Oearsakul T, Saeheng S, Chowchuvech V (2005) Non-shaved ventriculoperitoneal shunt in Thailand. J Clin Neurosci 12:147–149CrossRefPubMed
37.
Zurück zum Zitat Horgan MA, Piatt JH Jr (1997) Shaving of the scalp may increase the rate of infection in CSF shunt surgery. Pediatr Neurosurg 26:180–184CrossRefPubMed Horgan MA, Piatt JH Jr (1997) Shaving of the scalp may increase the rate of infection in CSF shunt surgery. Pediatr Neurosurg 26:180–184CrossRefPubMed
38.
Zurück zum Zitat Faillace WJ (1995) A no-touch technique protocol to diminish cerebrospinal fluid shunt infection. Surg Neurol 43:344–350CrossRefPubMed Faillace WJ (1995) A no-touch technique protocol to diminish cerebrospinal fluid shunt infection. Surg Neurol 43:344–350CrossRefPubMed
39.
Zurück zum Zitat Hirsch JF, 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 4:137–150PubMed Hirsch JF, 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 4:137–150PubMed
40.
Zurück zum Zitat Tacconelli E, Cataldo MA, Albanese A, Tumbarello M, Arduini E, Spanu T, Fadda G, Anile C, Maira G, Federico G, Cauda R (2008) Vancomycin versus cefazolin prophylaxis for cerebrospinal shunt placement in a hospital with a high prevalence of meticillin-resistant Staphylococcus aureus. J Hosp Infect 69:337–344CrossRefPubMed Tacconelli E, Cataldo MA, Albanese A, Tumbarello M, Arduini E, Spanu T, Fadda G, Anile C, Maira G, Federico G, Cauda R (2008) Vancomycin versus cefazolin prophylaxis for cerebrospinal shunt placement in a hospital with a high prevalence of meticillin-resistant Staphylococcus aureus. J Hosp Infect 69:337–344CrossRefPubMed
41.
Zurück zum Zitat Ragel BT, Browd SR, Schmidt RH (2006) Surgical shunt infection: significant reduction when using intraventricular and systemic antibiotic agents. J Neurosurg 105:242–247CrossRefPubMed Ragel BT, Browd SR, Schmidt RH (2006) Surgical shunt infection: significant reduction when using intraventricular and systemic antibiotic agents. J Neurosurg 105:242–247CrossRefPubMed
42.
Zurück zum Zitat Parsons HM (1974) What Happened at Hawthorne? New evidence suggests the Hawthorne effect resulted from operant reinforcement contingencies. Science 183:922–932CrossRefPubMed Parsons HM (1974) What Happened at Hawthorne? New evidence suggests the Hawthorne effect resulted from operant reinforcement contingencies. Science 183:922–932CrossRefPubMed
43.
Zurück zum Zitat Broekman MLD, van Beijnum J, Peul WC, Regli L (2011) Neurosurgery and shaving: what’s the evidence? J Neurosurg 115:670–678CrossRefPubMed Broekman MLD, van Beijnum J, Peul WC, Regli L (2011) Neurosurgery and shaving: what’s the evidence? J Neurosurg 115:670–678CrossRefPubMed
44.
Zurück zum Zitat Sebastian S (2012) Does preoperative scalp shaving result in fewer postoperative wound infections when compared with no scalp shaving? A systematic review. J Neurosci Nurs 44:149–156CrossRefPubMed Sebastian S (2012) Does preoperative scalp shaving result in fewer postoperative wound infections when compared with no scalp shaving? A systematic review. J Neurosci Nurs 44:149–156CrossRefPubMed
45.
Zurück zum Zitat Tanner J, Norrie P, Melen K (2011) Preoperative hair removal to reduce surgical site infection. Cochrane Database Syst Rev CD004122 Tanner J, Norrie P, Melen K (2011) Preoperative hair removal to reduce surgical site infection. Cochrane Database Syst Rev CD004122
46.
Zurück zum Zitat Darouiche RO, Wall MJ, Itani KMF, Otterson MF, Webb AL, Carrick MM, Miller HJ, Awad SS, Crosby CT, Mosier MC, Alsharif A, Berger DH (2010) Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med 362:18–26CrossRefPubMed Darouiche RO, Wall MJ, Itani KMF, Otterson MF, Webb AL, Carrick MM, Miller HJ, Awad SS, Crosby CT, Mosier MC, Alsharif A, Berger DH (2010) Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med 362:18–26CrossRefPubMed
47.
Zurück zum Zitat Noorani A, Rabey N, Walsh SR, Davies RJ (2010) Systematic review and meta-analysis of preoperative antisepsis with chlorhexidine versus povidone-iodine in clean-contaminated surgery. Br J Surg 97:1614–1620CrossRefPubMed Noorani A, Rabey N, Walsh SR, Davies RJ (2010) Systematic review and meta-analysis of preoperative antisepsis with chlorhexidine versus povidone-iodine in clean-contaminated surgery. Br J Surg 97:1614–1620CrossRefPubMed
48.
Zurück zum Zitat Dumville JC, McFarlane E, Edwards P, Lipp A, Holmes A (2013) Preoperative skin antiseptics for preventing surgical wound infections after clean surgery. Cochrane Database Syst Rev 3, CD003949PubMed Dumville JC, McFarlane E, Edwards P, Lipp A, Holmes A (2013) Preoperative skin antiseptics for preventing surgical wound infections after clean surgery. Cochrane Database Syst Rev 3, CD003949PubMed
49.
Zurück zum Zitat Gruber TJ, Riemer S, Rozzelle CJ (2009) Pediatric neurosurgical practice patterns designed to prevent cerebrospinal fluid shunt infection. Pediatr Neurosurg 45:456–460CrossRefPubMed Gruber TJ, Riemer S, Rozzelle CJ (2009) Pediatric neurosurgical practice patterns designed to prevent cerebrospinal fluid shunt infection. Pediatr Neurosurg 45:456–460CrossRefPubMed
Metadaten
Titel
Evidence-based interventions to reduce shunt infections: a systematic review
verfasst von
Nehaw Sarmey
Varun R. Kshettry
Michael F. Shriver
Ghaith Habboub
Andre G. Machado
Robert J. Weil
Publikationsdatum
01.04.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
Child's Nervous System / Ausgabe 4/2015
Print ISSN: 0256-7040
Elektronische ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-015-2637-2

Weitere Artikel der Ausgabe 4/2015

Child's Nervous System 4/2015 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.