Lack of efficacy of antibiotic-impregnated shunt systems in preventing shunt infections in children

Abstract

Shunt infection is a common and serious complication of cerebrospinal fluid (CSF) shunting most commonly caused by skin flora contamination at surgery. Recent studies indicate that the use of antibiotic-impregnated (AI) shunt systems may reduce the risk of postoperative shunt infections. We evaluated the incidence of shunt infections associated with the use of AI shunt catheters and compared it with the incidence associated with standard non-AI catheters. All shunt procedures performed by one surgeon using AI catheters were reviewed. An equal number of consecutive shunt procedures performed by the same surgeon using non-AI catheters were reviewed from the period immediately before the introduction of the AI system. Patients with <9 months of follow-up were excluded; all shunt infections and shunt-related complications were recorded. The proportions of infected shunts in the AI and control groups were compared using a chi (2) analysis. We reviewed 160 shunt procedures (80 per group). The infection rate was 5.0% among patients with AI catheters compared with 8.8% in the control group (P = 0.534, Fischer's exact). The average time to infection was similar between the two groups. Among the AI group, the shunt infection rate did not differ between ventricular catheter, distal catheter revisions, and revisions of ventricular and peritoneal tubing. In contrast with other reports, we found no significant reduction in the pediatric CSF shunt infection rate with the use of AI shunt systems. Any recommendation for or against the routine use of AI systems in children requires a prospective, blinded, randomized-controlled trial with adequate power.