Ventriculoperitoneal shunt infection: insights from a single-center comparative analysis

Abstract

Ventriculoperitoneal (VP) shunting is frequently associated with complications of which shunt-related infections are the most common. However, controversies still exist regarding the underlying factors. This study comparing peri-operative skin preparation agents was aimed at determining which factors among previously documented determinants of shunt infection are implicated in our practice setting. Fifty-four patients with hydrocephalus were allotted into two groups (Group I had pre- surgical skin preparation with povidone- iodine while Group II had pre- surgical skin preparation with 2% chlorhexidine gluconate-alcohol prior to VP shunting). The same brand and dose of prophylactic antibiotics were administered in both groups at induction of anaesthesia. Similar irrigation fluid constituted with similar antibiotics at the same concentration was used in both groups. Chhabra brand of VP shunt system as well as the same types of sutures was used for both groups. The patients were followed up over 6 months for VP shunt infection. Analysis of the data collected was done and p-value was set at ≤ 0.05. Of the 54 patients, 14 (25.9%) patients developed post-operative infections, with 9(64.3%) in Group I and the remaining 5(35.7%) in Group II. The infection rate for Group I (9 out of 30) was 30.0% while the infection rate for Group II (5 out of 24) was 20.8%. There was however no statistically significant difference in the rates of infection between both groups (p = 0.445). The occurrence of ventriculoperitoneal shunt infection was not found to be dependent on choice of the skin preparatory agent, cadre of the operating surgeon, duration of surgery, patients' gender, or body mass index (BMI). Findings from this study support previous recommendations that the choice of skin preparation agent for pre-operative skin antisepsis in VP shunting should simply be based on other factors such as the surgeon's preference, sound knowledge of the agent itself, its efficacy and cost. Type of study: Clinical research. Level of evidence: Level II.

Keywords: 2% chlorhexidine gluconate-alcohol; Determinants; Povidone iodine; Ventriculoperitoneal shunt infection.