HydroChat: Exploring Shunt Reinfections

HydroChat is an opportunity to share with our readers papers from academic journals and to discuss the implications for those whose lives are impacted by hydrocephalus.

This post features the recent HCRN publication by Dr. Tamara Simon: Reinfection after treatment of first cerebrospinal fluid shunt infection: a prospective observational cohort study. You can read the full article by clicking on the title.

Why is this paper important?

Placement of a shunt is a standard treatment for hydrocephalus. Unfortunately, there are a number of risks associated with having a shunt, and many shunts require a revision surgery within 2 years of placement. One of the causes of this is shunt infection. Furthermore, each revision surgery increases the risk of subsequent infections, which require additional revision surgeries. The researchers wanted to know what factors may affect the likelihood of a child who has already had a shunt infection to have another shunt infection (reinfection). One goal of the HCRN is to improve treatment for children with hydrocephalus by reducing the need for revision surgeries.

How was the study done?

The HCRN maintains a large database with information about thousands of children who have been treated for hydrocephalus. In order to find out what factors influence whether a child who has had a shunt infection will have a reinfection, the researchers looked at data from over 200 children who had a shunt infection over a span of 6 years. Some of the things they looked at were whether the surgical approach for infection treatment (either removing the whole shunt system, or leaving part of the shunt in place while treating with antibiotics) or the duration of antibiotics affected the likelihood of a reinfection. They also looked at the influence of things that cannot be changed, such as the age of the patient and the presence of other medical conditions.

What’s the takeaway?

The researchers found that it’s likely that the surgical approach for infection treatment has an impact on reinfection. It seems that it is best to completely remove the shunt when it is found to be infected, rather than leave part in while treating with antibiotics. Another factor that decreased reinfection risk was the use of rifampin in addition to the other antibiotics being used to treat the initial infection. They also saw that some other characteristics of the children being treated for shunt infection can affect likelihood of reinfection, such as age and the presence of other medical conditions. Having a higher number of shunt revision surgeries can also increase the likelihood of shunt reinfection.  There are a lot of things that can affect the outcome of a shunt, and keeping this new information in mind can help doctors as they develop the best treatment plans for children with hydrocephalus.