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Davidson H Hamer - One of the best experts on this subject based on the ideXlab platform.
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treatment of staphylococcus epidermidis ventriculo peritoneal Shunt Infection with linezolid
Journal of Infection, 2002Co-Authors: Christopher J Gill, M A Murphy, Davidson H HamerAbstract:Gram-positive bacterial meningitis frequently complicates ventriculo-peritoneal (VP) Shunts used for hydrocephalus. Linezolid, an oxazolidinone, is active against Gram-positive cocci, and has excellent CSF penetration. We present a 22-year-old woman who was cured of a Staphylococcus epidermidis VP Shunt Infection via Shunt removal and intravenous linezolid.
Peter P Sun - One of the best experts on this subject based on the ideXlab platform.
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ventriculoperitoneal Shunt Infection rates using a standard surgical technique including topical and intraventricular vancomycin the children s hospital oakland experience
Journal of Neurosurgery, 2020Co-Authors: Kunal P Raygor, Joan Y Hwang, Ryan R L Phelps, Kristen Ghoussaini, Patrick Wong, Rebecca Silvers, Lauren R Ostling, Peter P SunAbstract:OBJECTIVE Ventriculoperitoneal (VP) Shunt Infections are common complications after Shunt operations. Despite the use of intravenous antibiotics, the incidence of Infections remains high. Though antibiotic-impregnated catheters (AICs) are commonly used, another method of Infection prophylaxis is the use of intraventricular (IVT) antibiotics. The authors describe their single-institution experience with a standard Shunt protocol utilizing prophylactic IVT and topical vancomycin administration and report the incidence of pediatric Shunt Infections. METHODS Three hundred two patients undergoing VP Shunt procedures with IVT and topical vancomycin between 2006 and 2016 were included. Patients were excluded if their age at surgery was greater than 18 years. Shunt operations were performed at a single institution following a standard Shunt protocol implementing IVT and topical vancomycin. No AICs were used. Clinical data were retrospectively collected from the electronic health records. RESULTS Over the 11-year study period, 593 VP Shunt operations were performed with IVT and topical vancomycin, and a total of 19 Infections occurred (incidence 3.2% per procedure). The majority of Infections (n = 10, 52.6%) were caused by Staphylococcus epidermidis. The median time to Shunt Infection was 3.7 weeks. On multivariate analysis, the presence of a CSF leak (OR 31.5 [95% CI 8.8-112.6]) and age less than 6 months (OR 3.6 [95% CI 1.2-10.7]) were statistically significantly associated with the development of a Shunt Infection. A post hoc analysis comparing Infection rates after procedures that adhered to the Shunt protocol and those that did not administer IVT and topical vancomycin, plus historical controls, revealed a difference in Infection rates (3.2% vs 6.9%, p = 0.03). CONCLUSIONS The use of a standardized Shunt operation technique that includes IVT and topical vancomycin is associated with a total Shunt Infection incidence of 3.2% per procedure, which compares favorably with the reported rates of Shunt Infection in the literature. The majority of Infections occurred within 2 months of surgery and the most common causative organism was S. epidermidis. Young age (< 6 months) at the time of surgery and the presence of a postoperative CSF leak were statistically significantly associated with postoperative Shunt Infection on multivariate analysis. The results are hypothesis generating, and the authors propose that IVT and topical administration of vancomycin as part of a standardized Shunt operation protocol may be an appropriate option for preventing pediatric Shunt Infections.
Tamara D. Simon - One of the best experts on this subject based on the ideXlab platform.
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patient and treatment characteristics by infecting organism in cerebrospinal fluid Shunt Infection
Journal of the Pediatric Infectious Diseases Society, 2019Co-Authors: Abhaya V. Kulkarni, John R W Kestle, Tamara D. Simon, Matthew P. Kronman, Kathryn B. Whitlock, Samuel R. Browd, Richard Holubkov, Marcie LangleyAbstract:BACKGROUND Previous studies of cerebrospinal fluid (CSF) Shunt Infection treatment have been limited in size and unable to compare patient and treatment characteristics by infecting organism. Our objective was to describe variation in patient and treatment characteristics for children with first CSF Shunt Infection, stratified by infecting organism subgroups outlined in the 2017 Infectious Disease Society of America's (IDSA) guidelines. METHODS We studied a prospective cohort of children <18 years of age undergoing treatment for first CSF Shunt Infection at one of 7 Hydrocephalus Clinical Research Network hospitals from April 2008 to December 2012. Differences between infecting organism subgroups were described using univariate analyses and Fisher's exact tests. RESULTS There were 145 children whose Infections were diagnosed by CSF culture and addressed by IDSA guidelines, including 47 with Staphylococcus aureus, 52 with coagulase-negative Staphylococcus, 37 with Gram-negative bacilli, and 9 with Propionibacterium acnes. No differences in many patient and treatment characteristics were seen between infecting organism subgroups, including age at initial Shunt, gender, race, insurance, indication for Shunt, gastrostomy, tracheostomy, ultrasound, and/or endoscope use at all surgeries before Infection, or numbers of revisions before Infection. A larger proportion of Infections were caused by Gram-negative bacilli when antibiotic-impregnated catheters were used at initial Shunt placement (12 of 23, 52%) and/or subsequent revisions (11 of 23, 48%) compared with all other Infections (9 of 68 [13%] and 13 of 68 [19%], respectively). No differences in reInfection were observed between infecting organism subgroups. CONCLUSIONS The organism profile encountered at Infection differs when antibiotic-impregnated catheters are used, with a higher proportion of Gram-negative bacilli. This warrants further investigation given increasing adoption of antibiotic-impregnated catheters.
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reInfection rates following adherence to infectious diseases society of america guideline recommendations in first cerebrospinal fluid Shunt Infection treatment
Journal of Neurosurgery, 2019Co-Authors: Tamara D. Simon, Abhaya V. Kulkarni, John R W Kestle, Matthew P. Kronman, Kathryn B. Whitlock, Samuel R. Browd, Richard Holubkov, Marcie Langley, David D Limbrick, Thomas G. LuerssenAbstract:OBJECTIVECSF Shunt Infection treatment requires both surgical and antibiotic decisions. Using the Hydrocephalus Clinical Research Network (HCRN) Registry and 2004 Infectious Diseases Society of America (IDSA) guidelines that were not proactively distributed to HCRN providers, the authors previously found high adherence to surgical recommendations but poor adherence to intravenous (IV) antibiotic duration recommendations. In general, IV antibiotic duration was longer than recommended. In March 2017, new IDSA guidelines expanded upon the 2004 guidelines by including recommendations for selection of specific antibiotics. The objective of this study was to describe adherence to both 2004 and 2017 IDSA guideline recommendations for CSF Shunt Infection treatment, and to report reInfection rates associated with adherence to guideline recommendations.METHODSThe authors investigated a prospective cohort of children younger than 18 years of age who underwent treatment for first CSF Shunt Infection at one of 7 hospitals from April 2008 to December 2012. CSF Shunt Infection was diagnosed by recovery of bacteria from CSF culture (CSF-positive Infection). Adherence to 2004 and 2017 guideline recommendations was determined. Adherence to antibiotics was further classified as longer or shorter duration than guideline recommendations. ReInfection rates with 95% confidence intervals (CIs) were generated.RESULTSThere were 133 children with CSF-positive Infections addressed by 2004 IDSA guideline recommendations, with 124 at risk for reInfection. Zero reInfections were observed among those whose treatment was fully adherent (0/14, 0% [95% CI 0%-20%]), and 15 reInfections were observed among those whose Infection treatment was nonadherent (15/110, 14% [95% CI 8%-21%]). Among the 110 first Infections whose Infection treatment was nonadherent, 74 first Infections were treated for a longer duration than guidelines recommended and 9 developed reInfection (9/74, 12% [95% CI 6%-22%]). There were 145 children with CSF-positive Infections addressed by 2017 IDSA guideline recommendations, with 135 at risk for reInfection. No reInfections were observed among children whose treatment was fully adherent (0/3, 0% [95% CI 0%-64%]), and 18 reInfections were observed among those whose Infection treatment was nonadherent (18/132, 14% [95% CI 8%-21%]).CONCLUSIONSThere is no clear evidence that either adherence to IDSA guidelines or duration of treatment longer than recommended is associated with reduction in reInfection rates. Because IDSA guidelines recommend shorter IV antibiotic durations than are typically used, improvement efforts to reduce IV antibiotic use in CSF Shunt Infection treatment can and should utilize IDSA guidelines.
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Relationship of causative organism and time to Infection among children with cerebrospinal fluid Shunt Infection.
Journal of Neurosurgery: Pediatrics, 2019Co-Authors: Matthew R Test, John R W Kestle, Jay Riva-cambrin, Kathryn B. Whitlock, Marcie Langley, Tamara D. SimonAbstract:Objective Infection is a common complication of cerebrospinal fluid (CSF) Shunts, occurring in 6%-20% of children. Although studies are limited, Staphylococcus aureus is thought to cause more rapid and aggressive Infection than coagulase-negative Staphylococcus (CONS) or gram-negative organisms. The authors' objective was to evaluate the relationship between the causative organisms of CSF Shunt Infection and the timing of Infection. Methods The authors performed a retrospective cohort study of children who underwent CSF Shunt placement at a tertiary care children's hospital over a 9-year period and subsequently developed a CSF Shunt Infection. The primary predictor variable was the causative organism recovered from CSF culture, characterized as S. aureus, CONS, or gram-negative organisms. The primary outcome was time to Infection, defined as the number of days from most recent Shunt intervention to the diagnosis of the Infection. The association between causative organism and time to Infection was visualized using Kaplan-Meier curves, and statistical comparisons were made using nonparametric Kruskal-Wallis tests. Results Among 103 children in whom a CSF Shunt Infection developed, the causative organism was CONS in 57 (55%), S. aureus in 19 (18%), and gram-negative organisms in 9 (9%). The median time to Infection did not differ (p = 0.81) for Infections caused by CONS (20 days, IQR 11-40), S. aureus (26 days, IQR 12-95), and gram-negative organisms (23 days, IQR 17-34). Conclusions No significant difference in time to Infection based on the causative organism was observed among children with a CSF Shunt Infection.
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ReInfection after treatment of first cerebrospinal fluid Shunt Infection: a prospective observational cohort study.
Journal of neurosurgery. Pediatrics, 2018Co-Authors: Tamara D. Simon, Abhaya V. Kulkarni, Matthew P. Kronman, Kathryn B. Whitlock, Nancy E. Gove, Nicole Mayer-hamblett, Samuel R. Browd, D. Douglas Cochrane, Richard Holubkov, Marcie LangleyAbstract:OBJECTIVECSF Shunt Infection requires both surgical and antibiotic treatment. Surgical treatment includes either total Shunt removal with external ventricular drain (EVD) placement followed by new Shunt insertion, or distal Shunt externalization followed by new Shunt insertion once the CSF is sterile. Antibiotic treatment includes the administration of intravenous antibiotics. The Hydrocephalus Clinical Research Network (HCRN) registry provides a unique opportunity to understand reInfection following treatment for CSF Shunt Infection. This study examines the association of surgical and antibiotic decisions in the treatment of first CSF Shunt Infection with reInfection.METHODSA prospective cohort study of children undergoing treatment for first CSF Infection at 7 HCRN hospitals from April 2008 to December 2012 was performed. The HCRN consensus definition was used to define CSF Shunt Infection and reInfection. The key surgical predictor variable was surgical approach to treatment for CSF Shunt Infection, an...
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risk factors for first cerebrospinal fluid Shunt Infection findings from a multi center prospective cohort study
The Journal of Pediatrics, 2014Co-Authors: Abhaya V. Kulkarni, John R W Kestle, Tamara D. Simon, Kathryn B. Whitlock, Samuel R. Browd, Richard Holubkov, Marcie Langley, Jeremiah Butler, David D LimbrickAbstract:Objective To quantify the extent to which cerebrospinal fluid (CSF) Shunt revisions are associated with increased risk of CSF Shunt Infection, after adjusting for patient factors that may contribute to Infection risk. Study design We used the Hydrocephalus Clinical Research Network registry to assemble a large prospective 6-center cohort of 1036 children undergoing initial CSF Shunt placement between April 2008 and January 2012. The primary outcome of interest was first CSF Shunt Infection. Data for initial CSF Shunt placement and all subsequent CSF Shunt revisions prior to first CSF Shunt Infection, where applicable, were obtained. The risk of first Infection was estimated using a multivariable Cox proportional hazard model accounting for patient characteristics and CSF Shunt revisions, and is reported using hazard ratios (HRs) with 95% CI. Results Of the 102 children who developed first Infection within 12 months of placement, 33 (32%) followed one or more CSF Shunt revisions. Baseline factors independently associated with risk of first Infection included: gastrostomy tube (HR 2.0, 95% CI, 1.1, 3.3), age 6-12 months (HR 0.3, 95% CI, 0.1, 0.8), and prior neurosurgery (HR 0.4, 95% CI, 0.2, 0.9). After controlling for baseline factors, Infection risk was most significantly associated with the need for revision (1 revision vs none, HR 3.9, 95% CI, 2.2, 6.5; ≥2 revisions, HR 13.0, 95% CI, 6.5, 24.9). Conclusions This study quantifies the elevated risk of Infection associated with Shunt revisions observed in clinical practice. To reduce risk of Infection risk, further work should optimize revision procedures.
Christopher J Gill - One of the best experts on this subject based on the ideXlab platform.
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treatment of staphylococcus epidermidis ventriculo peritoneal Shunt Infection with linezolid
Journal of Infection, 2002Co-Authors: Christopher J Gill, M A Murphy, Davidson H HamerAbstract:Gram-positive bacterial meningitis frequently complicates ventriculo-peritoneal (VP) Shunts used for hydrocephalus. Linezolid, an oxazolidinone, is active against Gram-positive cocci, and has excellent CSF penetration. We present a 22-year-old woman who was cured of a Staphylococcus epidermidis VP Shunt Infection via Shunt removal and intravenous linezolid.
Erik J. Van Lindert - One of the best experts on this subject based on the ideXlab platform.
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route of antibiotic prophylaxis for prevention of cerebrospinal fluid Shunt Infection
Cochrane Database of Systematic Reviews, 2019Co-Authors: Sebastian Arts, Hieronymus D Boogaarts, Erik J. Van LindertAbstract:BACKGROUND: The main complication of cerebrospinal fluid (CSF) Shunt surgery is Shunt Infection. Prevention of these Shunt Infections consists of the perioperative use of antibiotics that can be administered in five different ways: orally; intravenously; intrathecally; topically; and via the implantation of antibiotic-impregnated Shunt catheters. OBJECTIVES: To determine the effect of different routes of antibiotic prophylaxis (i.e. oral, intravenous, intrathecal, topical and via antibiotic-impregnated Shunt catheters) on CSF-Shunt Infections in persons treated for hydrocephalus using internalised CSF Shunts. SEARCH METHODS: We conducted a systematic electronic search without restrictions on language, date or publication type. We performed the search on the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE and Embase, with the help of the Information Specialist of the Cochrane Multiple Sclerosis and Rare Diseases of the CNS Group. The search was performed in January 2018. SELECTION CRITERIA: All randomised and quasi-randomised controlled trials that studied the effect of antibiotic prophylaxis, in any dose or administration route, for the prevention of CSF-Shunt Infection in patients that were treated with an internal cerebrospinal fluid Shunt. Patients with external Shunts were not eligible. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data from included studies. We resolved disagreements by discussion or by referral to an independent researcher within our department when necessary. Analyses were also performed by at least two authors. MAIN RESULTS: We included a total of 11 small randomised controlled trials, containing 1109 participants, in this systematic review. Three of these studies included solely children, and the remaining eight included participants of all ages. Most studies were limited to the evaluation of ventriculoperitoneal Shunts. However, five studies included participants with ventriculoatrial Shunts, of which one study contained four participants with a subduroperitoneal Shunt. We judged four out of 11 (36%) trials at unclear risk of bias, while the remaining seven trials (64%) scored high risk of bias in one or more of the components assessed.We analysed all included studies in order to estimate the effect of antibiotic prophylaxis on the proportion of Shunt Infections regardless of administration route. Although the quality of evidence in these studies was low, there may be a positive effect of antibiotic prophylaxis on the number of participants who had Shunt Infections (RR 0.55, 95% CI 0.36 to 0.84), meaning a 55% reduction in the number of participants who had Shunt Infection compared with standard care or placebo.Within the different administration routes, only within intravenous administration of antibiotic prophylaxis there may be evidence of an effect on the risk of Shunt Infections (RR 0.55, 95% CI 0.33 to 0.90). However, this was the only route that contained more than two studies (8 studies; 797 participants). Evidence was uncertain for both, intrathecal administration of antibiotics (RR 0.73, 95% CI 0.28 to 1.93, 2 studies; 797 participants; low quality evidence) and antibiotic impregnated catheters (RR 0.36, 95% CI 0.10 to 1.24, 1 study; 110 participants; very low quality evidence) AUTHORS' CONCLUSIONS: Antibiotic prophylaxis may have a positive effect on lowering the number of participants who had Shunt Infections. However, the quality of included studies was low and the effect is not consistent within the different routes of administration that have been analysed. It is therefore uncertain whether prevention of Shunt Infection varies by different antibiotic agents, different administration routes, timing and doses; or by characteristics of patients, e.g. children and adults. The results of the review should be seen as hypothesis-generating rather than definitive, and the results should be confirmed in adequately powered trials or large multicentre studies in order to obtain high-quality evidence in the field of ventricular Shunt Infection prevention.
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Topical vancomycin reduces the cerebrospinal fluid Shunt Infection rate: A retrospective cohort study.
PloS one, 2018Co-Authors: Erik J. Van Lindert, Martine W. T. Van Bilsen, Michiel Van Der Flier, Eva Kolwijck, H. Delye, Jaap Ten OeverAbstract:Object Despite many efforts at reduction, cerebrospinal fluid (CSF) Shunt Infections are a major cause of morbidity in Shunt surgery, occurring in 5–15% of cases. To attempt to reduce the Shunt Infection rate at our institution, we added topical vancomycin (intraShunt and periShunt) to our existing Shunt Infection prevention protocol in 2012. Methods We performed a retrospective cohort study comparing all Shunted patients in January 2010 to December 2011 without vancomycin (control group, 263 procedures) to all patients who underwent Shunt surgery between April 2012 and December 2015 with vancomycin (intervention group, 499 procedures). Results The overall Shunt Infection rate significantly decreased from 6.8% (control group) to 3.0% (intervention group) (p = 0.023, absolute risk reduction 3.8%, relative risk reduction 56%). Multivariate logistic regression analysis confirmed that the addition of topical vancomycin showed that cases treated under a protocol of topical vancomycin were associated with a decreased Shunt Infection rate (odds ratio [OR] 0.49 95% CI 0.25–0.998; p = 0.049). Age < 1 year was associated with an increased risk of Infection (OR) 4.41, 95% CI 2,10–9,26; p = 0.001). Time from surgery to Infection was significantly prolonged in the intervention group (p = 0.001). Conclusion Adding intraoperative vancomycin to a Shunt Infection prevention protocol significantly reduces CSF Shunt Infection rate.
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Radboud University Medical Center Shunt Infection prevention protocol, version 2012.
2018Co-Authors: Erik J. Van Lindert, Michiel Van Der Flier, Eva Kolwijck, Martine Van Bilsen, Hans Delye, Jaap Ten OeverAbstract:Radboud University Medical Center Shunt Infection prevention protocol, version 2012.
