Abstract
BackgroundInfection is a major complication following cerebral spinal fluid (CSF) diversion procedures for hydrocephalus. However, pediatric risk factors for surgical site infection (SSI) are currently not well defined. Because a SSI prevention bundle is increasingly introduced, the purpose of this study was to evaluate risk factors associated with SSIs following CSF diversion surgeries following a SSI bundle at a single quaternary care pediatric hospital.MethodsWe performed a retrospective cohort study of patients undergoing CSF diversion procedures from 2017 to 2019. SSIs were identified prospectively through continuous surveillance. We performed unadjusted logistic regression analyses and univariate analyses to determine an association between SSIs and patient demographics, comorbidities and perioperative factors to identify independent risk factors for SSI.ResultsWe identified a total of 558 CSF diversion procedures with an overall SSI rate of 3.4%. The SSI rates for shunt, external ventricular drain (EVD) placement, and endoscopic third ventriculostomy (ETV) were 4.3, 6.9 and 0%, respectively. Among 323 shunt operations, receipt of clindamycin as perioperative prophylaxis and presence of cardiac disease were significantly associated with SSI (O.R. 4.99, 95% C.I. 1.27–19.70, p = 0.02 for the former, and O.R. 7.19, 95% C.I. 1.35–38.35, p = 0.02 for the latter). No risk factors for SSI were identified among 72 EVD procedures.ConclusionWe identified receipt of clindamycin as perioperative prophylaxis and the presence of cardiac disease as risk factors for SSI in shunt procedures. Cefazolin is recommended as a standard antibiotic for perioperative prophylaxis. Knowing that unsubstantiated beta-lactam allergy label is a significant medical problem, efforts should be made to clarify beta-lactam allergy status to maximize the number of patients who can receive cefazolin for prophylaxis before shunt placement. Further research is needed to elucidate the mechanism by which cardiac disease may increase SSI risk after shunt procedures.
Highlights
Hydrocephalus results from a disturbance of the normal pulsatile flow of cerebrospinal fluid (CSF), resulting in its abnormal accumulation within the cerebral ventricles
Statistical analysis We reported continuous variables as either means with standard deviation (SD) for normally distributed variables or medians and interquartile ranges (IQR) for variables without normal distribution
We found that receipt of clindamycin for perioperative prophylaxis and comorbid cardiac disease were significantly associated with surgical site infection (SSI) in shunt surgery
Summary
Hydrocephalus results from a disturbance of the normal pulsatile flow of cerebrospinal fluid (CSF), resulting in its abnormal accumulation within the cerebral ventricles. This can be alleviated in the short term by insertion of a reservoir or external ventricular drain (EVD). The rate of surgical site infections (SSIs) after neurosurgery is generally low, the clinical and financial consequences of SSIs after CSF diversion procedures are substantial [2]. To compare what has been reported with our recent experience, we conducted an observational, retrospective study to identify factors associated with SSIs after CSF diversion procedures in a pediatric cohort in a single institution. Infection is a major complication following cerebral spinal fluid (CSF) diversion procedures for hydrocephalus. Because a SSI prevention bundle is increasingly introduced, the purpose of this study was to evaluate risk factors associated with SSIs following CSF diversion surgeries following a SSI bundle at a single quaternary care pediatric hospital
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