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. 2012 Jun;31(6):551-6.
doi: 10.1097/INF.0b013e31824da5bd.

Revision surgeries are associated with significant increased risk of subsequent cerebrospinal fluid shunt infection

Tamara D Simon  1 , Kathryn B Whitlock, Jay Riva-Cambrin, John R W Kestle, Margaret Rosenfeld, J Michael Dean, Richard Holubkov, Marcie Langley, Nicole Mayer Hamblett
Affiliations

Revision surgeries are associated with significant increased risk of subsequent cerebrospinal fluid shunt infection

Tamara D Simon et al. Pediatr Infect Dis J. 2012 Jun.

Abstract

Background: The object of this study was to determine whether cerebrospinal fluid (CSF) shunt revision(s) are associated with increased risk of CSF shunt infection, after adjusting for baseline factors that contribute to infection risk.

Methods: This was a retrospective cohort study of 579 children aged 0-18 years who underwent initial CSF shunt placement between January 01, 1997 and October 12, 2006 at a tertiary care children's hospital. The outcome of interest was CSF shunt infection. Data for all subsequent CSF shunt revisions leading up to and including the initial CSF shunt infection, when applicable, were obtained. The likelihood of infection was determined using a Cox proportional hazard model accounting for patient characteristics and CSF shunt revisions, and is reported using hazard ratios (HR) with 95% confidence intervals (CI).

Results: There were 123 children who developed infection. Baseline factors independently associated with hazard of infection included age 0 to <6 months at CSF shunt placement (HR 2.4, 95% CI: 1.02-6.7) and myelomeningocele (HR 0.4, 95% CI: 0.2-0.8). Controlling for baseline factors, the risk of infection after shunt revision was significantly greater than at the time of initial placement (HR 3.0, 95% CI: 1.9-4.7), and this risk increased as numbers of revisions increased (≥2 revisions HR 6.5, 95% CI: 3.6-11.4).

Conclusions: Although younger age is associated with increased hazard of infection, subsequent CSF shunt revision significantly increases infection risk.

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Conflict of interest statement

Conflicts of Interest and Source of Funding: None of the authors have potential financial, personal, or professional conflicts of interest to disclose. This publication was supported by a PCMC Innovative Research Grant and the Children’s Health Research Center at the University of Utah which provided salary support for ML. Ongoing support for investigators includes Award K23NS062900 from the National Institute of Neurological Disorders And Stroke (NINDS) for TDS and KW; Seattle Children’s Center for Clinical and Translational Research and CTSA Grant Number ULI RR025014 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH) for TDS, KW, and NMH; and the Child Health Corporation of America via the Pediatric Research in Inpatient Setting Network Executive Council for TDS. Past support for investigators included Award 1RC1NS068943-01 from NINDS for TDS, JRC, JK, and RH. None of the sponsors participated in design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the NCRR or NIH.

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