Associations of Standard Care, Intrathecal Antibiotics, and Antibiotic-Impregnated Catheters With Cerebrospinal Fluid Shunt Infection Organisms and Resistance

Sabrina Sedano; Matthew P Kronman; Kathryn B Whitlock; Chuan Zhou; Susan E Coffin; Jason S Hauptman; Evan Heller; Francesco T Mangano; Ian F Pollack; Joshua K Schaffzin; Emily Thorell; Benjamin C Warf; Tamara D Simon

doi:10.1093/jpids/piad064

Associations of Standard Care, Intrathecal Antibiotics, and Antibiotic-Impregnated Catheters With Cerebrospinal Fluid Shunt Infection Organisms and Resistance

J Pediatric Infect Dis Soc. 2023 Sep 27;12(9):504-512. doi: 10.1093/jpids/piad064.

Authors

Sabrina Sedano¹, Matthew P Kronman^{2

3}, Kathryn B Whitlock⁴, Chuan Zhou^{2

3}, Susan E Coffin⁵, Jason S Hauptman^{2

6}, Evan Heller⁷, Francesco T Mangano⁸, Ian F Pollack⁹, Joshua K Schaffzin¹⁰, Emily Thorell⁷, Benjamin C Warf¹¹, Tamara D Simon^{1

12

13}

Affiliations

¹ Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA.
² Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA.
³ Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA.
⁴ New Harmony Statistical Consulting LLC, Clinton, Washington, USA.
⁵ Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
⁶ Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA.
⁷ Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA.
⁸ Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
⁹ Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
¹⁰ Department of Pediatrics, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada.
¹¹ Department of Neurosurgery, Harvard School of Medicine, Boston, Massachusetts, USA.
¹² Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, California, USA.
¹³ The Saban Research Institute, Los Angeles, California, USA.

Abstract

Background: Infection prevention techniques used during cerebrospinal fluid (CSF) shunt surgery include: (1) standard perioperative intravenous antibiotics, (2) intrathecal (IT) antibiotics, (3) antibiotic-impregnated catheter (AIC) shunt tubing, or (4) Both IT and AIC. These techniques have not been assessed against one another for their impact on the infecting organisms and patterns of antimicrobial resistance.

Methods: We performed a retrospective longitudinal observational cohort study of children with initial CSF shunt placement between January 2007 and December 2012 at 6 US hospitals. Data were collected electronically from the Pediatric Health Information Systems+ (PHIS+) database, and augmented with standardized chart review. Only subjects with positive CSF cultures were included in this study.

Results: Of 1,723 children whose initial shunt placement occurred during the study period, 196 (11%) developed infection, with 157 (80%) having positive CSF cultures. Of these 157 subjects, 69 (44%) received standard care, 28 (18%) received AIC, 55 (35%) received IT antibiotics, and 5 (3%) received Both at the preceding surgery. The most common organisms involved in monomicrobial infections were Staphylococcus aureus (38, 24%), coagulase-negative staphylococci (36, 23%), and Cutibacterium acnes (6, 4%). Compared with standard care, the other infection prevention techniques were not significantly associated with changes to infecting organisms; AIC was associated with decreased odds of methicillin resistance among coagulase-negative staphylococci.

Conclusions: Because no association was found between infection prevention technique and infecting organisms when compared to standard care, other considerations such as tolerability, availability, and cost should inform decisions about infection prevention during CSF shunt placement surgery.

Keywords: antibiotic resistance; antibiotic stewardship; cerebrospinal fluid; surgical site infections; ventriculoperitoneal shunt.

© The Author(s) 2023. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Publication types

Observational Study

MeSH terms

Anti-Bacterial Agents* / therapeutic use
Catheters
Cerebrospinal Fluid Shunts / adverse effects
Child
Coagulase*
Humans
Retrospective Studies

Substances

Anti-Bacterial Agents
Coagulase

Abstract

Publication types

MeSH terms

Substances

Grants and funding