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. 2024 Jan 5;33(4):349-358.
doi: 10.3171/2023.11.PEDS2337. Print 2024 Apr 1.

Utilization trends in cerebrospinal fluid shunt infection prevention techniques in the United States from 2007 to 2015

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

Utilization trends in cerebrospinal fluid shunt infection prevention techniques in the United States from 2007 to 2015

Stacey Podkovik et al. J Neurosurg Pediatr. .

Abstract

Objective: The objective of this study was to describe trends in the utilization of infection prevention techniques (standard care, intrathecal [IT] antibiotics, antibiotic-impregnated catheters [AICs], and combination of IT antibiotics and AICs) among participating hospitals over time.

Methods: This retrospective cohort study at six large children's hospitals between 2007 and 2015 included children ≤ 18 years of age who underwent initial shunt placement between 2007 and 2012. Pediatric Health Information System + (PHIS+) data were augmented with chart review data for all shunt surgeries that occurred prior to the first shunt infection. The Pearson chi-square test was used to test for differences in outcomes.

Results: In total, 1723 eligible children had initial shunt placement between 2007 and 2012, with 3094 shunt surgeries through 2015. Differences were noted between hospitals in gestational age, etiology of hydrocephalus, and race and ethnicity, but not sex, weight at surgery, and previous surgeries. Utilization of infection prevention techniques varied across participating hospitals. Hydrocephalus Clinical Research Network hospitals used more IT antibiotics in 2007-2011; after 2012, increasing adoption of AICs was observed in most hospitals.

Conclusions: A consistent trend of decreasing IT antibiotic use and increased AIC utilization was observed after 2012, except for hospital B, which consistently used AICs.

Keywords: cerebrospinal fluid; hydrocephalus; infection; ventriculoperitoneal shunt.

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Conflict of interest statement

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Figures

FIG. 1.
FIG. 1.
Comparison of infection prevention techniques among children’s hospitals over quarterly blocks of time: all sites (A), hospital A (B), hospital B (C), and hospital C (D). Abx = antibiotic.
FIG. 2.
FIG. 2.
Comparison of infection prevention techniques among children’s hospitals over quarterly blocks of time: hospital D (A), hospital E (B), and hospital F (C).
FIG. 3.
FIG. 3.
Machine learning was used to determine factors contributing to the selection of infection prevention technique. Neuro = neurosurgical.
See this image and copyright information in PMC

References

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