Infection rates during eras of intrathecal antibiotic use followed by antibiotic-impregnated catheter use in prevention of cerebrospinal fluid shunt infection.

Autor:	Simon TD; 1The Saban Research Institute, Children's Hospital Los Angeles, California.; 2Division of Hospital Medicine, Department of Pediatrics, University of Southern California, Keck School of Medicine, Los Angeles, California., Hayati Rezvan P; 1The Saban Research Institute, Children's Hospital Los Angeles, California., Coffin SE; 3Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania., Hall M; 4Children's Hospital Association, Lenexa, Kansas., Hauptman JS; Departments of5Neurological Surgery and., Kronman MP; 6Pediatrics, University of Washington, School of Medicine, Seattle, Washington., Mangano FT; Departments of7Neurosurgery and., Podkovik S; 8Department of Neurological Surgery, Riverside University Health Sciences Medical Center, Riverside, California., Pollack IF; 9Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania., Schaffzin JK; 10Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.; 11Faculty of Medicine, University of Ottawa, Ontario, Canada., Thorell E; 12Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah., Warf BC; 13Department of Neurosurgery, Harvard School of Medicine, Boston, Massachusetts., Zhou C; 6Pediatrics, University of Washington, School of Medicine, Seattle, Washington.; 14Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington; and., Whitlock KB; 15New Harmony Statistical Consulting, Clinton, Washington.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgery. Pediatrics [J Neurosurg Pediatr] 2024 Jul 19; Vol. 34 (4), pp. 357-364. Date of Electronic Publication: 2024 Jul 19 (Print Publication: 2024).
DOI:	10.3171/2024.5.PEDS23372
Abstrakt:	Objective: The Hydrocephalus Clinical Research Network (HCRN) implemented a perioperative infection prevention bundle for all CSF shunt surgeries in 2007 that included the relatively unproven technique of intrathecal instillation of the broad-spectrum antibiotics vancomycin and gentamicin into the shunt. In the meantime, the field debated the use of antibiotic-impregnated catheter (AIC) shunt tubing using clindamycin and rifampin, an increasingly widespread, but expensive and controversial, technique. It is unknown whether there were changes in infecting organisms associated with the use of these techniques during CSF shunt surgery at the hospital level. Key comparison periods include during the use of intrathecal antibiotics (period 1 from June 1, 2007, to December 31, 2011, at HCRN hospitals) and AIC (period 2 from January 1, 2012, to December 31, 2015, at HCRN as well as increasing over time at non-HCRN hospitals) and only standard use of routine prophylactic antibiotics (period 1 at non-HCRN hospitals). The aim of this study was to examine rates of CSF shunt surgery-related infections from 2007 to 2012 at the hospital level, including HCRN and non-HCRN hospitals, with a focus on infections with gram-negative organisms. Methods: The authors conducted a retrospective observational cohort study at 6 children's hospitals with enrollment from 2007 to 2012 and surveillance through 2015. Bimonthly rates of shunt surgery-related infections were summarized to produce an overall hospital-specific time series, as well as by HCRN/non-HCRN status. An interrupted time series analysis was performed to assess the impact of change in HCRN perioperative infection prevention bundle on overall bimonthly infection rates. Quarterly rates of gram-negative shunt surgery-related infections were summarized to produce an overall hospital-specific time series. Results: The overall bimonthly CSF shunt infection rate over time did not change significantly from 2007 to 2012. There was no difference in the trajectory of infection rates between HCRN and non-HCRN hospitals during the entire study period. No change in distributions of gram-negative organism infections was observed in hospitals from 2007 to 2015. Conclusions: There were no differences observed in hospital-level infection rates for low-risk patients undergoing CSF shunt surgery. This included analyses based on participation in the HCRN network, given their regular use of intrathecal antibiotics in period 1 and a focus on gram-negative infections with increasing adoption of AICs in period 2.
Databáze:	MEDLINE
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