INFECTION FOLLOWING CEREBROSPINAL FLUID SHUNT INSERTION IN THE REPUBLIC OF IRELAND: A RETROSPECTIVE AUDIT
ESPID Education. Burns K. Jun 7, 2011; 7675
Dr. Karen Burns
Dr. Karen Burns

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Abstract
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Background
A retrospective audit of infections arising following cerebrospinal fluid (CSF) shunt insertions, 2008-2009 inclusive, was conducted.
Methods
A standardised data collection form was completed for each procedure. US Centers for Disease Control and Prevention (CDC) definitions of surgical site infection (SSI) were utilised
Results
Ninety-one children underwent 130 CSF shunt insertions, 65 (50%) using clindamycin and rifampicin-impregnated catheters. At admission, 63 (69%) were aged under one year and 62 (68%) weighed under 10kg. Post-operative infection occurred following 27 (21%)procedures: 12 episodes of SSI and 15 episodes of meningitis. Eighty-eight percent of culture-positive SSI were due to S. aureus and 77% of culture-positive meningitis episodes were due to coagulase-negative staphylococci. The average length of stay for infection following CSF shunt insertion was 27 days versus 17 days without (p=0.04). No infection-related deaths were recorded. SSI following shunt revision or replacement following temporary external ventricular drain (EVD)[9%] was more common than following primary shunt insertion only [5%]. Post-operative meningitis occurred in 18% of shunts replaced following EVD versus primary shunt insertion (11%). When antimicrobial impregnated catheters were used post-operative infection developed in 20% vs 23% for non-antimicrobial catheters.
Conclusions
This study highlights the persisting problem of infection following CSF shunt insertion, despite use of antimicrobial-impregnated catheters particularly in young small children. The predominance of coagulase-negative staphylococci causing meningitis following CSF shunt insertion has implications for empiric choice of therapy when treating suspected infection
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