Reduction in shunt infection using antibiotic impregnated CSF shunt catheters: an Australian prospective study.

ABSTRACT

Antibiotic impregnated shunt catheters have emerged as a promising tool against the continuing challenge of shunt infection. We present our prospective evaluation of the efficacy of antibiotic (rifampicin and clindamycin) impregnated cerebrospinal fluid (CSF) shunt catheters (AIC) in a mixed paediatric and adult Australian population. We have prospectively evaluated all the cerebrospinal fluid shunt procedures carried out in our institution over a 3-year period since July 2002, after the introduction of AIC in our practice. Patient demographics, indication for shunt procedure, risk factors for infection, shunt infections and other relevant factors were documented. The data has been compared with similar data collected over the previous 7 years of our experience with non-antibiotic impregnated catheters for CSF shunt procedures. Pearson's chi-square and Fisher's exact tests are used for statistical evaluation. From July 2002 to June 2005, 243 shunt procedures were carried out using AICs in 178 patients. There were three shunt infections (1.2%). Rigorous retrospective evaluation of shunt procedures over the preceding 7 years revealed 36 infections in 551 shunt procedures (6.5%). This reduction in the infection rate was statistically significant (p=0.0015 on Pearson's chi-square test and p=0.000529 on Fisher's exact test). We also report that the introduction of ceftriaxone prophylaxis during this period was associated with a reduction in Gram-negative shunt infection, but no effect on overall infection rate. We report rifampicin and clindamycin impregnated CSF shunt catheters significantly reduce the rate of shunt infection in Australian clinical practice. This data and the literature support the routine usage of AIC for all CSF shunt procedures.