Artikel
Risk factors for ventriculoperitoneal shunt infection and triggering infectious pathogens
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Autoren
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A. Germanishvilli
- Klinik für Neurochirurgie, Universitätsklinikum Jena, Friedrich-Schiller-Univerität Jena
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P. Dünisch
- Klinik für Neurochirurgie, Universitätsklinikum Jena, Friedrich-Schiller-Univerität Jena
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J. Walter
- Klinik für Neurochirurgie, Universitätsklinikum Jena, Friedrich-Schiller-Univerität Jena
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R. Kalff
- Klinik für Neurochirurgie, Universitätsklinikum Jena, Friedrich-Schiller-Univerität Jena
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Y. Sakr
- Klinik für Anästhesie und Intensivmedizin, Universitätsklinikum Jena, Friedrich-Schiller-Univerität Jena
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C. Ewald
- Klinik für Neurochirurgie, Universitätsklinikum Jena, Friedrich-Schiller-Univerität Jena
| Veröffentlicht: | 4. Juni 2012 |
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Gliederung
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Objective: Cerebrospinal fluid shunt implantations account for a significant number of neurosurgical admissions and procedures. 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, or insertion of a new shunt system. The aim of our study was to report risk factors that may predispose to ventriculoperitoneal shunt infection in these patients.
Methods: We included 491 patients at our institution between 01/2004 and 12/2010. Clinical and radiological findings were retrieved retrospectively. A Shunt infection was defined as elevated cell count in the cerebrospinal fluid, the possible microbiological isolation of the triggering germ at the ventricular and/or peritoneal catheter or with a purulent infection of the surrounding tissue found during the reoperation. To identify the risk factors predisposing to shunt infection we performed a multivariate analysis with CSF shunt infection as the dependent variable.
Results: Forty-two CSF Shunts (9%) in 491 patients developed infection a median time of 31 days (IQR: interquartile range, 14–70 days) after insertion. 15 infected shunts were previously on intensive care unit a median time of 12 days (IQR: 7–21 days). A younger age (Odds ratio (OR)=0.98, 95% confidence interval (CI):0.96–0.99, p=0.003, and a pre-existing EVD which lies over a period of 5–10 day (OR=3.5, 95% CI:1.43–8.78, p<0.006) or more than 10 days (OR=3.8, 95% CI:1.34–10.98, p<0.001) where independent risk factors for shunt infection. The bacterial organism early after shunt surgery (<14 days, Staphylococcus aureus and staphylococcus epidermidis) were the same after late shunt surgery (>14 days).
Conclusions: Two risk factors where independently associated with CSF shunt infection, including a younger age and a pre-existing EVD which lies up to 10 or more days before shunt insertion. In most cases the infecting agent is introduced at the same time of shunt insertion due to skin flora.
