gms | German Medical Science

61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

Incidence of shunt-related complications and infections in critically ill neurosurgical patients

Meeting Abstract

  • Kerim-Hakan Sitoci - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Carl-Gustav-Carus an der Technischen Universität Dresden, Deutschland
  • Tareq Juratli - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Carl-Gustav-Carus an der Technischen Universität Dresden, Deutschland
  • Florian Wrage - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Carl-Gustav-Carus an der Technischen Universität Dresden, Deutschland
  • Stefan Monecke - Institut für Medizinische Mikrobiologie und Hygiene, Universitätsklinikum Carl-Gustav-Carus an der Technischen Universität Dresden, Deutschland
  • Gabriele Schackert - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Carl-Gustav-Carus an der Technischen Universität Dresden, Deutschland
  • Matthias Kirsch - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Carl-Gustav-Carus an der Technischen Universität Dresden, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP1774

DOI: 10.3205/10dgnc245, URN: urn:nbn:de:0183-10dgnc2455

Published: September 16, 2010

© 2010 Sitoci et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objective: Ventriculoperitoneal and ventriculoatrial shunt-related infections expose neurosurgical patients to additional risks and morbidities. If possible, critically ill neurosurgical patients (those requiring medical treatment in the intensive care unit) are at an increased risk for unwanted side effects. The incidence of shunt-related complications varies in the literature between 5% and 27%. The purpose of this study was to determine the incidence of shunt-related complications in this critically ill patient population.

Methods: The data of 789 neurosurgical pts. who underwent a ventriculostomy at our institute between 10/2003 and 05/2009 and who were treated in the ICU were retrospectively analysed. Of these pts., 427 required permanent CSF drainage and shunt implantation. An analysis of the diagnosis at admission, demographic data, comorbidities, shunt complications and the microbiology, hematologic and CSF laboratory values were assessed. Shunt-related infection was defined as a microbiological verification of bacteria in CSF or in cultures of explanted shunt material. The standard procedure in our hospital does not include the routine application of antibiotics after shunt implantation.

Results: Of the 427 pts that required implantation of a shunt system, 50 (11.7%) were re-admitted due to a suspected shunt malfunction. They underwent surgical exploration or explantation of the shunt. In 20 (4.7%) pts, CSF infection or colonization of the shunt material was detected. The remaining 30 (7%) pts had a shunt malfunction due to mechanical complications such as shunt dislocation (n=17; 3.9%), valve obstruction (n=8; 1.8%), CSF fistula (n=2; 0.5%) and gastrointestinal complications (n=3; 0.7%). Of all 50 re-admitted pts, only 2 (0.5%) had a preceding ventriculostomy-related infection (VRI). The encountered pathogens were mainly staphyloccus aureus (n=7; 35%) and coagulase neg. staphylococci (n=10; 50%). In 3 of the 20 pts. a gastrointestinal focus was causing the shunt infection.

Conclusions: In this population of pts. that had severe co-morbidities, a shunt infection rate of 4.7% was encountered. 40% of re-admissions for shunt dysfunction were due to infection. Otherwise, mechanical complications were the reason for readmission. Further improvements of the infection rate might require perioperative antibiotic administration.