2312. Utility of Intrathecal Antibiotic Administration in the Reduction of Ventriculoperitoneal (VP) Shunt Infections in our Urban Referral Health Center

Abstract

Abstract Background Infection is one of the primary causes of VP shunt failure, with an incidence rate of 7%-14%. Systemic antibiotics, administered intravenously (IV), are considered the standard of care (SOC) for perioperative prophylaxis. Prophylactic intrathecal (IT) administration of antibiotics, in addition to SOC, is practiced by some surgeons at our institution. Our objective was to study the impact of this modality on VP shunt infections. Methods A retrospective review of all VP shunt procedures at our institution from 2018–2020 was performed. Patients with active VP shunt infection were excluded. We compared the incidence of 90-day postoperative shunt infection in patients who received IT and SOC antibiotics (intervention group) to patients who only received SOC IV antibiotics (control group). Data collection included demographics, comorbidities, prophylactic antibiotics used, and pathogens implicated in shunt infections. T-test or Mann-Whitney U test was used for comparison of continuous variables; chi-square or Fisher’s exact test was used to assess the relationship between categorical variables. A value of p < 0.05, on two-tailed testing, was considered statistically significant. Results A total of 112 patients were included in the study. Control and intervention arms comprised 54 (48.2%) and 58 patients (51.8%), respectively. All patients received parenteral perioperative antibiotics. The most commonly used agent was cefazolin (83.9%). Patients in the intervention arm received 4 mg of gentamicin and 5 mg of vancomycin intrathecally. Baseline characteristics were not statistically different between the groups. Among the 112 patients, 12 (10.7%) developed shunt infection; 4 in the intervention and 8 in the control arm. Infection rates were not statistically different in these groups (χ2 (1) =1.83, p= 0.176). However, there was a statistically significant association between history of prior shunt (uninfected) placement and post-operative shunt infection (Fisher’s exact test, p = 0.025). Conclusion Our study did not reveal additional benefit of prophylactic IT antibiotic use in decreasing VP shunt infections. History of prior shunt placement was identified as risk factor, however. Limitations include relatively small sample size, retrospective, and a single-center study. Disclosures All Authors: No reported disclosures.