J Korean Med Sci.  2012 Dec;27(12):1563-1568. 10.3346/jkms.2012.27.12.1563.

Incidence and Risk Factors of Ventriculoperitoneal Shunt Infections in Children: A Study of 333 Consecutive Shunts in 6 Years

• Lee JK
• Seok JY
• Lee JH
• Choi EH
• Phi JH
• Kim SK
• Wang KC
• Lee HJ

• KMID: 2157983
• DOI: http://doi.org/10.3346/jkms.2012.27.12.1563

Abstract

The major aims of this study were to estimate the infection rate and recognize the risk factor for ventriculoperitoneal (VP) shunt infections in children. To analyze shunt infection rate and identify risk factors, a retrospective cohort analysis of 333 consecutive VP shunt series was performed at Seoul National University Children's Hospital in Korea between January 2005 and February 2011. Overall, 35 shunts (10.5%) were infected, which represented an infection rate of 0.075 infection cases per shunt per year. VP shunt infection occurred at a median of 1 month (range, 6 days to 8 months) after insertion. An independent risk factor for shunt infection was undergoing an operation before the first year of life (relative risk 2.31; 95% confidence interval, 1.19-4.48). The most common causative microorganism was coagulase-negative staphylococci in 16 (45.7%) followed by Staphylococcus aureus in 8 (22.9%). Methicillin resistance rate was 83.3% among coagulase-negative staphylococci and S. aureus. In this study, cerebrospinal fluid shunt infection rate was 10.5%. Infection was frequently caused by methicillin-resistant coagulase-negative staphylococci and S. aureus within two months after shunt surgery. Vancomycin may be considered as the preoperative prophylaxis for shunt surgery in a situation where methicillin resistance rate is very high.

Keyword

Ventriculoperitoneal Shunt; Infection; Prophylaxis; Child

MeSH Terms

Anti-Bacterial Agents/therapeutic use
Bacterial Infections/drug therapy/*epidemiology/microbiology
Child
Child, Preschool
Cohort Studies
Humans
Hydrocephalus/surgery
Incidence
Infant
Infant, Newborn
Male
Methicillin-Resistant Staphylococcus aureus/isolation & purification
Retrospective Studies
Risk Factors
Staphylococcus/isolation & purification
Surgical Wound Infection/drug therapy/*epidemiology/etiology
Vancomycin/therapeutic use
Ventriculoperitoneal Shunt/*adverse effects
Anti-Bacterial Agents
Vancomycin

Figure

• 

  Fig. 1 Time interval from shunt placement to infection. Of the 35 shunt infections, 18 infections (51.4%) occurred within 1 month of shunt insertion, and 32 infections (91.4%) occurred within 3 months of shunt insertion (range 6 days to 8 months).

• 

  Fig. 2 Surgical management of shunt infection. External ventricular drain in 22 cases (68.8%); externalization of the shunt in 3 cases (9.4%); and both of these procedures in 7 cases (21.9%).

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