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Observational Study
. 2023 Sep 27;12(9):504-512.
doi: 10.1093/jpids/piad064.

Associations of Standard Care, Intrathecal Antibiotics, and Antibiotic-Impregnated Catheters With Cerebrospinal Fluid Shunt Infection Organisms and Resistance

Sabrina Sedano  1 , Matthew P Kronman  2   3 , Kathryn B Whitlock  4 , Chuan Zhou  2   3 , Susan E Coffin  5 , Jason S Hauptman  2   6 , Evan Heller  7 , Francesco T Mangano  8 , Ian F Pollack  9 , Joshua K Schaffzin  10 , Emily Thorell  7 , Benjamin C Warf  11 , Tamara D Simon  1   12   13
Affiliations
Observational Study

Associations of Standard Care, Intrathecal Antibiotics, and Antibiotic-Impregnated Catheters With Cerebrospinal Fluid Shunt Infection Organisms and Resistance

Sabrina Sedano et al. J Pediatric Infect Dis Soc. .

Abstract

Background: Infection prevention techniques used during cerebrospinal fluid (CSF) shunt surgery include: (1) standard perioperative intravenous antibiotics, (2) intrathecal (IT) antibiotics, (3) antibiotic-impregnated catheter (AIC) shunt tubing, or (4) Both IT and AIC. These techniques have not been assessed against one another for their impact on the infecting organisms and patterns of antimicrobial resistance.

Methods: We performed a retrospective longitudinal observational cohort study of children with initial CSF shunt placement between January 2007 and December 2012 at 6 US hospitals. Data were collected electronically from the Pediatric Health Information Systems+ (PHIS+) database, and augmented with standardized chart review. Only subjects with positive CSF cultures were included in this study.

Results: Of 1,723 children whose initial shunt placement occurred during the study period, 196 (11%) developed infection, with 157 (80%) having positive CSF cultures. Of these 157 subjects, 69 (44%) received standard care, 28 (18%) received AIC, 55 (35%) received IT antibiotics, and 5 (3%) received Both at the preceding surgery. The most common organisms involved in monomicrobial infections were Staphylococcus aureus (38, 24%), coagulase-negative staphylococci (36, 23%), and Cutibacterium acnes (6, 4%). Compared with standard care, the other infection prevention techniques were not significantly associated with changes to infecting organisms; AIC was associated with decreased odds of methicillin resistance among coagulase-negative staphylococci.

Conclusions: Because no association was found between infection prevention technique and infecting organisms when compared to standard care, other considerations such as tolerability, availability, and cost should inform decisions about infection prevention during CSF shunt placement surgery.

Keywords: antibiotic resistance; antibiotic stewardship; cerebrospinal fluid; surgical site infections; ventriculoperitoneal shunt.

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References

    1. Kestle JR. Pediatric hydrocephalus: current management. Neurol Clin 2003; 21:883–95, vii. - PubMed
    1. Odio C, McCracken GH Jr, Nelson JD. CSF shunt infections in pediatrics. A seven-year experience. Am J Dis Child 1984; 138:1103–8. - PubMed
    1. Nelson JD. Cerebrospinal fluid shunt infections. Pediatr Infect Dis 1984; 3:S30–2. - PubMed
    1. Sells CJ, Shurtleff DB, Loeser JD. Gram-negative cerebrospinal fluid shunt-associated infections. Pediatrics 1977; 59:614–8. - PubMed
    1. Fan-Havard P, Nahata MC. Treatment and prevention of infections of cerebrospinal fluid shunts. Clin Pharm 1987; 6:866–80. - PubMed

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