HCRN investigators Drs. Simon, Kestle, and Riva-Cambrin recently studied shunt infection. They used a database of 675 children and asked the question “What factors are associated with a child with shunt infection returning with infection after treatment?” . More specifically they looked at the role of surgery in treating shunt infections. Some children have their shunt removed and a new shunt placed after treatment with antibiotics; others have the shunt externalized followed sometime later after antibiotic treatment by placement of a new shunt; other had shunt initially externalized and then the shunt was removed entirely and replaced with a new shunt; some children had shunts removed; and some were treated without surgery (by antibiotics alone). The chance of the infection coming back was about 15% and this usually occurred in the first few weeks (average 21 days). This didn’t vary significantly with the two main surgical approaches (shunt removal/new shunt and externalization). In addition the chance of re-infection didn’t appear to be related to patient characteristics, hospital volume, surgeon volume or duration of antibiotic therapy.
Data were extracted from hospital discharge diagnosis codes, which are limited in detail, so the conclusions are preliminary. Clearly more work is needed in this area. The shunt infection registry, currently underway at five (soon to be seven) HCRN centers, is collecting detailed information on infection and re-infections. Future studies of these questions using detailed, prospectively collected HCRN data will help us get better answers.
The study was published recently in the Journal of Neurosugery and they have kindly provided us with a complimentary link to the full article.