Infection Rate with Application of an Antibiotic-impregnated Catheter for Shunt Implantation in Children – A Retrospective Analysis

Abstract

Background: The infection rate of hydrocephalus shunts in children amounts figures of up to 25% and the according mortality rate is alarming high nowadays yet. An antibiotic impregnated shunt-catheter (AIS) was designed to reduce the incidence of shunt infections.

Patients and method: In a non randomized trial 56 children were examined between January 2002 inclusive December 2007. The minimal follow-up was six months. Only children were included, who were shunted for the first time. In the study group (n=34) AIS (Bactiseal^® Codman, Johnson & Johnson, MA, Boston, USA) were used, while the control group (n=22) was provided with conventional, not-antibiotic impregnated catheters. To compare the risk profile for shunt infections, we defined, – according to the literature –, some risk factors.

Results: Despite the incidence of shunt infections has been supposed to be higher according to the higher risk profile of the AIS group compared with controls, the shunt infection rate of the AIS group was lower than the shunt infection rate in the control group.

Conclusions: Apparently, AIS can reduce the incidence of shunt infections in children. Further prospective trials with a larger cohort are necessary for a statistically significant prove.

Zusammenfassung

Hintergrund: Infektionsraten von bis zu 25% und eine erschreckend hohe Mortalität dieser Komplikation kennzeichnen auch heute noch Shunt-Infektionen bei Kindern. Antibiotikaimprägnierte Shunt-Katheter (AIS) wurden entwickelt, um die Häufigkeit von Shunt-Infektionen zu senken.

Patienten und Methode: In einer nicht randomisierten Untersuchung wurden 56 Kinder zwischen Januar 2002 und Dezember 2007 erfasst. Das minimale Follow up betrug sechs Monate. Es wurden nur Kinder mit einer erstmaligen Shunt-Implantation eingeschlossen. Kinder der Studiengruppe (n=34) erhielten AIS (Bactiseal^® Codman, Johnson & Johnson, MA, Boston, USA), während in der Kontrollgruppe (n=22) konventionelle, nicht Antibiotika imprägnierte Katheter verwendet wurden. Um das Risiko für Shunt-Infektionen beider Gruppen vergleichen zu können, definierten wir entsprechend der Literatur entsprechende Risikofaktoren.

Ergebnisse: Trotz der Tatsache, dass das Risiko einer Shunt-Infektion gemäß der Risikofaktoren in der AIS-Gruppe höher war als in der Kontrollgruppe, war die Häufigkeit von Shunt-Infektionen in der AIS-Gruppe geringer als in der Kontrollgruppe.

Schlussfolgerung: Antibiotikaimprägnierte Shunt-Katheter können möglicherweise die Häufigkeit von Shunt-Infektionen bei Kindern senken. Es sind jedoch weitere prospektive Studien mit einer größeren Patientenanzahl notwendig, um dies statistisch abzusichern.

Key words

hydrocephalus - children - antibiotic impregnated catheter - shunt infection

Schlüsselwörter

Hydrozephalus - Kinder - antibiotikaimprägnierte Katheter - Shunt-Infektion

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Correspondence