Response to validity of the results of a perioperative protocol to reduce shunt infections

Abstract

Comment to Dr. Kshettry We thank Dr. Varun R Kshettry for comments on our article “Significant reduction of shunt infection rate in children below 1 year of age after implementation of a perioperative protocol”. The impact of using antibiotic-impregnated shunt (AIS) catheters is relevant, and something we considered during the statistical analyses of the material. While the AIS catheters were used at the discretion of the treating physician, a number of surgeons were performing the shunt operations. During the study period, the department had not implemented a strict protocol on the use of AIS catheters. The decision to use an AIS catheter was subjective to the surgeon. Hence, the AIS catheters were not used exclusively in the high-risk population. Based on our available information, we cannot conclude that the use of AIS catheters made a systematic impact, or that those receiving AIS catheters were more at risk for infection. Accordingly, while Dr. Kshettry makes an important comment regarding the use of AIS catheters, we have no reason to believe that this aspect significantly affects the conclusions of our work. Nevertheless, in a continued effort to reduce shunt infection rate, we recommend more extensive use of AIS catheters together with better protocol compliance.