Comparison of shunt infection incidence in high-risk subgroups receiving antibiotic-impregnated versus standard shunts

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This paper confirms the role of antibiotic-impregnated internal shunts (AIS) in significantly reducing the incidence of shunt infections also in high-risk pediatric patients. What I found particularly interesting in this paper was the similar incidence of oxacillin-resistant Staphylococcus aureus infections between the group with AIS implantations (1.4%) and those with non-antibiotic-impregnated (NAIS) shunts (1.6%). In the same direction, the paper indicates that the AIS result in a reduction of nonstaphylococcal gram-positive infections (AIS group 0% vs. NAIS 1.05%). Furthermore, the authors confirm the similar overall incidence of gram-negative germ infections in the two groups (AIS=0.79%; NAIS=1.05%), demonstrating that implanting an AIS does not favor infections by germs which are not covered by the locally released antibiotics. In a different but also “high-risk” environment, our recent experience with the perioperative management of hydrocephalus in children operated on for a posterior fossa tumor is somewhat similar to that reported by the authors. Actually, in our series, the use of non-antibiotic-impregnated external ventricular drainages (AIEVD) significantly decreased the occurrence of contamination of the cerebrospinal fluid (intended as early CSF detection of germs without any clinical manifestation) if compared with an homogeneous group of children managed with nonimpregnated catheters (non-antibiotic-impregnated external ventricular drainages, NAIEVD); namely, the rate of CSF contamination in the