Pirotte BJ, Lubansu A, Bruneau M, Loqa C, Van Cutsem N, Brotchi J. Sterile surgical technique for shunt placement reduces the shunt infection rate in children: preliminary analysis of a prospective protocol in 115 consecutive procedures. Child's Nervous System. 2007 Nov;23(11):1251-61. Epub 2007 Aug 18.
OBJECTIVE: The objective of this study was to evaluate whether the rigid application of a sterile protocol for shunt placement was applicable on a routine basis and allowed the reduction of shunt infections (SI) in children.
MATERIALS AND METHODS: Since 2001, a rigid sterile protocol for shunt placement in children using neither antibiotic-impregnated catheters nor laminar airflow was prospectively applied at Erasme Hospital, Brussels, Belgium. For assessing the protocol efficacy before continuation, we preliminarily analyzed the results of the first 100 operated children (43 females, 57 males, 49 aged <12 months; 115 consecutive shunt placement/revision procedures). All procedures were performed by the same senior surgeon, one assistant, one circulating nurse, one anesthesiologist. The sterile protocol was rigidly imposed to these four staff members: uniformed surgical technique; limited implant and skin edge manipulation; minimized human circulation in the room; scheduling surgery as first morning operation; avoiding postoperative cerebrospinal fluid (CSF) leak; double gloving; procedures of less than 30-min duration; systemic antibiotics prophylaxis. We analyzed separately: (1) children carrying an increased risk of SI (n = 38) due to preoperative external ventricular drainage, CSF leak, meningitis, glucocorticoids, chemotherapy; (2) children aged <12 months; (3) procedures for shunt revision.
RESULTS: Errors in protocol application were recorded in 71/115 procedures. They were mainly done by non-surgical staff, decreased with time and were medically justified in some young children. Surprisingly, no SI occurred (follow-up, 4 to 70 months). One child developed an appendicitis with peritonitis (Streptococcus faecalis) after 6 months. No SI was found. After peritonitis was cured, shunt reinsertion was uneventful.
CONCLUSION: These preliminary results suggest that a uniform and drastic sterile surgical technique for shunt placement: (1) can be rigidly applied on a routine basis; (2) can lower the early SI rate below 1%; (3) might have a stronger impact to reduce SI than using antibiotic-impregnated catheters and optimizing the operative environment such as using laminar airflow and reducing the non-surgical staff. This last issue will be evaluated further in the present ongoing protocol.
PMID: 17705062
Showing posts with label Shunt Infection. Show all posts
Showing posts with label Shunt Infection. Show all posts
Friday, October 12, 2007
Tuesday, July 24, 2007
Effect of an intraoperative double-gloving strategy on the incidence of cerebrospinal fluid shunt infection.
Tulipan N, Cleves MA. Effect of an intraoperative double-gloving strategy on the incidence of cerebrospinal fluid shunt infection. Journal of Neurosurgery. 2006 Jan;104(1 Suppl):5-8.
OBJECT: The purpose of this study was to determine the effect of double gloving on cerebrospinal fluid (CSF) shunt infection rates.
METHODS: Data obtained in two large groups of patients, one in which the surgical personnel wore a single pair of gloves each and the other in which the personnel wore two pairs of gloves each, were retrospectively studied. The study involved 863 patients. The overall infection rate in the single-gloved group was 15.2%, whereas it was 6.7% in the double-gloved group (p = 0.0002). Of additional interest was the marked difference between the overall shunt infection rates in younger children (< 11.3 years of age; 15.7%) and older children (> 11.3 years of age) and adults (6.7%; p < 0.00005).
CONCLUSIONS: The strategy of wearing two pairs of gloves while performing surgery appears to reduce the incidence of postoperative shunt infection by more than 50%. The incidence of shunt infection is highly age dependent. The shunt infection rate may be further reduced by carefully studying the individual variables associated with the shunt insertion procedure.
PMID: 16509473
OBJECT: The purpose of this study was to determine the effect of double gloving on cerebrospinal fluid (CSF) shunt infection rates.
METHODS: Data obtained in two large groups of patients, one in which the surgical personnel wore a single pair of gloves each and the other in which the personnel wore two pairs of gloves each, were retrospectively studied. The study involved 863 patients. The overall infection rate in the single-gloved group was 15.2%, whereas it was 6.7% in the double-gloved group (p = 0.0002). Of additional interest was the marked difference between the overall shunt infection rates in younger children (< 11.3 years of age; 15.7%) and older children (> 11.3 years of age) and adults (6.7%; p < 0.00005).
CONCLUSIONS: The strategy of wearing two pairs of gloves while performing surgery appears to reduce the incidence of postoperative shunt infection by more than 50%. The incidence of shunt infection is highly age dependent. The shunt infection rate may be further reduced by carefully studying the individual variables associated with the shunt insertion procedure.
PMID: 16509473
Management of shunt infections: a multicenter pilot study.
Kestle JR, Garton HJ, Whitehead WE, Drake JM, Kulkarni AV, Cochrane DD, Muszynski C, Walker ML. Management of shunt infections: a multicenter pilot study. Journal of Neurosurgery. 2006 Sep;105(3 Suppl):177-81.
OBJECT: Approximately 10% of cerebrospinal fluid (CSF) shunt operations are associated with infection and require removal or externalization of the shunt, in-hospital treatment with antibiotic agents, and insertion of a new shunt. In a previous survey, the authors identified substantial variation in the duration of antibiotic therapy as well as the duration of hospital stay. The present multicenter pilot study was undertaken to evaluate current strategies in the treatment of shunt infection.
METHODS: Patients were enrolled in the study if they had a successful treatment of a CSF shunt infection proved by culture of a CSF specimen. Details of their care and the incidence of culture-proved reinfection were recorded. Seventy patients from 10 centers were followed up for 1 year after their CSF shunt infection. The initial management of the infection was shunt externalization in 17 patients, shunt removal and external ventricular drain insertion in 50, and antibiotic treatment alone in three. Reinfection occurred in 18 patients (26%). Twelve of the 18 reinfections were caused by the same organism and six were due to new organisms. The treatment time varied from 4 to 47 days, with a mean of 17.4 days for those who later experienced a reinfection compared with 16.2 days for those who did not. The most common organism (Staphylococcus epidermidis, 34 patients) was associated with a reinfection rate of 29% and a mean treatment time of 12.8 days for those who suffered reinfection and 12.5 days for those who did not.
CONCLUSIONS: Reinfection after treatment of a CSF shunt infection is alarmingly common. According to the data available, the incidence of reinfection does not appear to be related to the duration of antibiotic therapy.
PMID: 16970229
OBJECT: Approximately 10% of cerebrospinal fluid (CSF) shunt operations are associated with infection and require removal or externalization of the shunt, in-hospital treatment with antibiotic agents, and insertion of a new shunt. In a previous survey, the authors identified substantial variation in the duration of antibiotic therapy as well as the duration of hospital stay. The present multicenter pilot study was undertaken to evaluate current strategies in the treatment of shunt infection.
METHODS: Patients were enrolled in the study if they had a successful treatment of a CSF shunt infection proved by culture of a CSF specimen. Details of their care and the incidence of culture-proved reinfection were recorded. Seventy patients from 10 centers were followed up for 1 year after their CSF shunt infection. The initial management of the infection was shunt externalization in 17 patients, shunt removal and external ventricular drain insertion in 50, and antibiotic treatment alone in three. Reinfection occurred in 18 patients (26%). Twelve of the 18 reinfections were caused by the same organism and six were due to new organisms. The treatment time varied from 4 to 47 days, with a mean of 17.4 days for those who later experienced a reinfection compared with 16.2 days for those who did not. The most common organism (Staphylococcus epidermidis, 34 patients) was associated with a reinfection rate of 29% and a mean treatment time of 12.8 days for those who suffered reinfection and 12.5 days for those who did not.
CONCLUSIONS: Reinfection after treatment of a CSF shunt infection is alarmingly common. According to the data available, the incidence of reinfection does not appear to be related to the duration of antibiotic therapy.
PMID: 16970229
Evaluation and management of shunt infections in children with hydrocephalus.
Duhaime AC. Evaluation and management of shunt infections in children with hydrocephalus. Clinical Pediatrics 2006 Oct;45(8):705-13.
Shunt infections constitute one of the main risks of shunt surgery for hydrocephalus, which is the single most common type of surgery performed by pediatric neurosurgeons. Infectious complications are responsible for increased morbidity and mortality, lengthy hospitalizations, and high cost. Most modern series report infection rates approaching 10% of all shunt procedures. Despite the high incidence of this complication, optimal management is still unknown, and research on prevention has been hampered by single-institution series and small numbers. This article will review the history, causes, presentation, management, and outcome from shunt infections in children. Pitfalls in diagnosis and management will be reviewed. Finally, prevention strategies and research questions still remaining in this area will be outlined.
PMID: 16968955
Shunt infections constitute one of the main risks of shunt surgery for hydrocephalus, which is the single most common type of surgery performed by pediatric neurosurgeons. Infectious complications are responsible for increased morbidity and mortality, lengthy hospitalizations, and high cost. Most modern series report infection rates approaching 10% of all shunt procedures. Despite the high incidence of this complication, optimal management is still unknown, and research on prevention has been hampered by single-institution series and small numbers. This article will review the history, causes, presentation, management, and outcome from shunt infections in children. Pitfalls in diagnosis and management will be reviewed. Finally, prevention strategies and research questions still remaining in this area will be outlined.
PMID: 16968955
Shunt infection: is there a near-miss scenario?
Thompson DN, Hartley JC, Hayward RD. Shunt infection: is there a near-miss scenario? Journal of Neurosurgery. 2007 Jan;106(1 Suppl):15-9.
OBJECT: The aim of this study was to establish whether microbiological contamination at the time of shunt insertion can be detected and used to predict the likelihood of subsequent shunt infection.
METHODS: A prospective study of pediatric patients undergoing primary shunt insertion was undertaken. Following the protocol devised for this study, three swab samples were collected from the surgical wounds during each procedure. These samples were incubated and subcultured, and the isolates were identified and stored. In patients who subsequently presented with clinical evidence of shunt infection, cerebrospinal fluid (CSF) was analyzed using microscopy, tissue cultures, and sensitivity testing. The organisms isolated at the time of shunt insertion and those responsible for subsequent shunt infection were then compared. The study population consisted of 107 pediatric patients. Because one patient underwent placement of an additional contralateral shunt system, there were 108 total shunt insertions yielding 325 swab samples. Organisms were identified in cultures of 50 swab samples (15%) obtained in 40 patients (37%). In seven of these 40 patients (17.5%) a CSF infection subsequently developed. In only one patient was the infectious organism the same as that isolated from the swab specimens. In an additional six patients (8.8%) a CSF infection occurred despite the lack of growth in the cultures from intraoperative swab samples.
CONCLUSIONS: The organisms responsible for shunt infection were rarely detected in the operative wound at the time of shunt insertion, leading the authors to conclude that the vulnerable period for bacterial colonization of shunts may not be restricted to the operative procedure as is commonly believed, but may extend throughout the postoperative period of wound healing. These findings have implications not only for a better understanding of the cause of shunt infections but also for the development of strategies to prevent them.
PMID: 17233307
OBJECT: The aim of this study was to establish whether microbiological contamination at the time of shunt insertion can be detected and used to predict the likelihood of subsequent shunt infection.
METHODS: A prospective study of pediatric patients undergoing primary shunt insertion was undertaken. Following the protocol devised for this study, three swab samples were collected from the surgical wounds during each procedure. These samples were incubated and subcultured, and the isolates were identified and stored. In patients who subsequently presented with clinical evidence of shunt infection, cerebrospinal fluid (CSF) was analyzed using microscopy, tissue cultures, and sensitivity testing. The organisms isolated at the time of shunt insertion and those responsible for subsequent shunt infection were then compared. The study population consisted of 107 pediatric patients. Because one patient underwent placement of an additional contralateral shunt system, there were 108 total shunt insertions yielding 325 swab samples. Organisms were identified in cultures of 50 swab samples (15%) obtained in 40 patients (37%). In seven of these 40 patients (17.5%) a CSF infection subsequently developed. In only one patient was the infectious organism the same as that isolated from the swab specimens. In an additional six patients (8.8%) a CSF infection occurred despite the lack of growth in the cultures from intraoperative swab samples.
CONCLUSIONS: The organisms responsible for shunt infection were rarely detected in the operative wound at the time of shunt insertion, leading the authors to conclude that the vulnerable period for bacterial colonization of shunts may not be restricted to the operative procedure as is commonly believed, but may extend throughout the postoperative period of wound healing. These findings have implications not only for a better understanding of the cause of shunt infections but also for the development of strategies to prevent them.
PMID: 17233307
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