A multicenter multinational registry for assessing ventriculoperitoneal shunt infections for hydrocephalus

Paul Steinbok, Ruth Milner, Deepak Agrawal, Elana Farace, Gilberto K.K. Leung, Ivan Ng, Tadanori Tomita, Ernest Wang, Ning Wang, George Kwok Chu Wong, Liang Fu Zhou

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background: Reported infection rates after ventriculoperitoneal shunt surgery vary from 1 to 25%. Antibiotic-impregnated (AI) catheters may reduce shunt infection rates, but this is uncertain. Objective: To establish a prospective shunt registry to evaluate short-term (3-month) infection rates associated with ventriculoperitoneal shunts and standard or AI catheters during surgical treatment of hydrocephalus. Methods: A prospective, multicenter, noncontrolled, open-label registry investigated patients with de novo catheter implantation or catheter replacement of an existing ventriculoperitoneal shunt. The primary outcome was shunt infection. Results: A total of 440 patients were entered into the registry at 10 sites: 3 in North America, 2 in Singapore, 4 in China and 1 in India. Seven patients were excluded. Of the 433 remaining patients, 314 had new shunts and 119 were revisions. Shunt infections occurred in 14 of 433 patients (3.2%) overall and in 2 of 37 infants (5.2%) younger than 1 year. AI catheters were used in 46 of 433 patients at 7 centers. The shunt infection rate was 0 of 46 for shunts with AI catheters and 14 of 387 (3.6%) without AI catheters. Infection rates were similar with AI catheters, adjusting for age and catheter type. Conclusion: The overall shunt infection rate was lower than in previous multicentered studies. The low infection rate and low rate of AI catheter use precludes any meaningful statement regarding the value of AI catheters in reducing the infection rate. Consideration should be given to performing a well designed, adequately powered, prospective randomized controlled trial to determine whether AI catheters reduce shunt infection rates.

Original languageEnglish (US)
Pages (from-to)1303-1310
Number of pages8
JournalNeurosurgery
Volume67
Issue number5
DOIs
StatePublished - Nov 1 2010

Fingerprint

Ventriculoperitoneal Shunt
Hydrocephalus
Registries
Catheters
Anti-Bacterial Agents
Infection
Singapore
North America
India
China
Randomized Controlled Trials

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Steinbok, Paul ; Milner, Ruth ; Agrawal, Deepak ; Farace, Elana ; Leung, Gilberto K.K. ; Ng, Ivan ; Tomita, Tadanori ; Wang, Ernest ; Wang, Ning ; Chu Wong, George Kwok ; Zhou, Liang Fu. / A multicenter multinational registry for assessing ventriculoperitoneal shunt infections for hydrocephalus. In: Neurosurgery. 2010 ; Vol. 67, No. 5. pp. 1303-1310.
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abstract = "Background: Reported infection rates after ventriculoperitoneal shunt surgery vary from 1 to 25{\%}. Antibiotic-impregnated (AI) catheters may reduce shunt infection rates, but this is uncertain. Objective: To establish a prospective shunt registry to evaluate short-term (3-month) infection rates associated with ventriculoperitoneal shunts and standard or AI catheters during surgical treatment of hydrocephalus. Methods: A prospective, multicenter, noncontrolled, open-label registry investigated patients with de novo catheter implantation or catheter replacement of an existing ventriculoperitoneal shunt. The primary outcome was shunt infection. Results: A total of 440 patients were entered into the registry at 10 sites: 3 in North America, 2 in Singapore, 4 in China and 1 in India. Seven patients were excluded. Of the 433 remaining patients, 314 had new shunts and 119 were revisions. Shunt infections occurred in 14 of 433 patients (3.2{\%}) overall and in 2 of 37 infants (5.2{\%}) younger than 1 year. AI catheters were used in 46 of 433 patients at 7 centers. The shunt infection rate was 0 of 46 for shunts with AI catheters and 14 of 387 (3.6{\%}) without AI catheters. Infection rates were similar with AI catheters, adjusting for age and catheter type. Conclusion: The overall shunt infection rate was lower than in previous multicentered studies. The low infection rate and low rate of AI catheter use precludes any meaningful statement regarding the value of AI catheters in reducing the infection rate. Consideration should be given to performing a well designed, adequately powered, prospective randomized controlled trial to determine whether AI catheters reduce shunt infection rates.",
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Steinbok, P, Milner, R, Agrawal, D, Farace, E, Leung, GKK, Ng, I, Tomita, T, Wang, E, Wang, N, Chu Wong, GK & Zhou, LF 2010, 'A multicenter multinational registry for assessing ventriculoperitoneal shunt infections for hydrocephalus', Neurosurgery, vol. 67, no. 5, pp. 1303-1310. https://doi.org/10.1227/NEU.0b013e3181f07e76

A multicenter multinational registry for assessing ventriculoperitoneal shunt infections for hydrocephalus. / Steinbok, Paul; Milner, Ruth; Agrawal, Deepak; Farace, Elana; Leung, Gilberto K.K.; Ng, Ivan; Tomita, Tadanori; Wang, Ernest; Wang, Ning; Chu Wong, George Kwok; Zhou, Liang Fu.

In: Neurosurgery, Vol. 67, No. 5, 01.11.2010, p. 1303-1310.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A multicenter multinational registry for assessing ventriculoperitoneal shunt infections for hydrocephalus

AU - Steinbok, Paul

AU - Milner, Ruth

AU - Agrawal, Deepak

AU - Farace, Elana

AU - Leung, Gilberto K.K.

AU - Ng, Ivan

AU - Tomita, Tadanori

AU - Wang, Ernest

AU - Wang, Ning

AU - Chu Wong, George Kwok

AU - Zhou, Liang Fu

PY - 2010/11/1

Y1 - 2010/11/1

N2 - Background: Reported infection rates after ventriculoperitoneal shunt surgery vary from 1 to 25%. Antibiotic-impregnated (AI) catheters may reduce shunt infection rates, but this is uncertain. Objective: To establish a prospective shunt registry to evaluate short-term (3-month) infection rates associated with ventriculoperitoneal shunts and standard or AI catheters during surgical treatment of hydrocephalus. Methods: A prospective, multicenter, noncontrolled, open-label registry investigated patients with de novo catheter implantation or catheter replacement of an existing ventriculoperitoneal shunt. The primary outcome was shunt infection. Results: A total of 440 patients were entered into the registry at 10 sites: 3 in North America, 2 in Singapore, 4 in China and 1 in India. Seven patients were excluded. Of the 433 remaining patients, 314 had new shunts and 119 were revisions. Shunt infections occurred in 14 of 433 patients (3.2%) overall and in 2 of 37 infants (5.2%) younger than 1 year. AI catheters were used in 46 of 433 patients at 7 centers. The shunt infection rate was 0 of 46 for shunts with AI catheters and 14 of 387 (3.6%) without AI catheters. Infection rates were similar with AI catheters, adjusting for age and catheter type. Conclusion: The overall shunt infection rate was lower than in previous multicentered studies. The low infection rate and low rate of AI catheter use precludes any meaningful statement regarding the value of AI catheters in reducing the infection rate. Consideration should be given to performing a well designed, adequately powered, prospective randomized controlled trial to determine whether AI catheters reduce shunt infection rates.

AB - Background: Reported infection rates after ventriculoperitoneal shunt surgery vary from 1 to 25%. Antibiotic-impregnated (AI) catheters may reduce shunt infection rates, but this is uncertain. Objective: To establish a prospective shunt registry to evaluate short-term (3-month) infection rates associated with ventriculoperitoneal shunts and standard or AI catheters during surgical treatment of hydrocephalus. Methods: A prospective, multicenter, noncontrolled, open-label registry investigated patients with de novo catheter implantation or catheter replacement of an existing ventriculoperitoneal shunt. The primary outcome was shunt infection. Results: A total of 440 patients were entered into the registry at 10 sites: 3 in North America, 2 in Singapore, 4 in China and 1 in India. Seven patients were excluded. Of the 433 remaining patients, 314 had new shunts and 119 were revisions. Shunt infections occurred in 14 of 433 patients (3.2%) overall and in 2 of 37 infants (5.2%) younger than 1 year. AI catheters were used in 46 of 433 patients at 7 centers. The shunt infection rate was 0 of 46 for shunts with AI catheters and 14 of 387 (3.6%) without AI catheters. Infection rates were similar with AI catheters, adjusting for age and catheter type. Conclusion: The overall shunt infection rate was lower than in previous multicentered studies. The low infection rate and low rate of AI catheter use precludes any meaningful statement regarding the value of AI catheters in reducing the infection rate. Consideration should be given to performing a well designed, adequately powered, prospective randomized controlled trial to determine whether AI catheters reduce shunt infection rates.

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