Analyzing ventriculoperitoneal shunt infections: insights from institutional data

Abstract

Objective
Ventriculoperitoneal (VP) shunt infections are prevalent and have significant negative prognostic impacts on both individuals and the healthcare systems. This institutional observational study’s main objectives were to ascertain the prevalence of shunt infections and investigate the associated risk factors, identify microbiological pathogens, and asses antibiotic susceptibility patterns in treated patients.


Methods
This single-centred prospective observational cohort analysis included patients undergoing ventriculoperitoneal shunt surgeries within three years. Patients were followed for atleast one year until reaching the primary endpoint of the shunt infection. The review and analysis of data on demographic, clinical, and surgical characteristics were done in this study. Cerebrospinal fluid (CSF) and shunt tube samples from cases undergoing shunt revision were sent for culture examination to identify the bacterial pathogens and investigate the prevailing patterns of antibiotic susceptibility. Univariate and multivariate analyses were utilized to investigate relationships among variables contributing to shunt infection.


Results

During the study period, 336 ventriculoperitoneal shunt procedures were completed. Of those, 96 cases (28.57%) involved shunt revisions, and 37 of those cases’ shunt revisions (11.01%) were brought on by infections. Fever (59.45%) and headache (70.27%) were the two most typical symptoms in patients with shunt infections. Variables like post-traumatic hydrocephalus, post-hemorrhagic hydrocephalus, infantile age, and longer surgery durations > 75 min were linked significantly (
p
 < 0.05) to the bacterial infection. It was determined that neither the surgical environment nor the clinical background of the surgeon correlated directly with the incidence of shunt infections. The most prevalent isolated bacteria was found to be Staphylococcus aureus (64.9%). Furthermore, bacterial strains exhibited higher susceptibility to imipenem compared to commonly employed quinolones and cephalosporins.



Conclusions
Shunt infections often manifest early signs within months and demand prompt attention. According to our intensive research on risk factors, shunt infection has more prevalence in people with post-traumatic and posthemorrhagic hydrocephalus. Prolonged surgical durations and infancy are both at an elevated risk of infection. Given these predisposing risk factors, prioritized attention and vigilance should be placed on these sensitive cases. In order to effectively prevent and treat shunt infections, it is recommended that institutions implement and adhere to comprehensive antibiotic policies. These policies should be carefully formulated to address the specific challenges associated with managing and controlling infections related to ventriculoperitoneal shunt procedures.