Journal Article10.1007/S00381-005-0037-8
Cerebrospinal fluid shunt infection: risk factors and long-term follow-up.
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TL;DR: Long-term follow-up of shunted children is necessary to evaluate the real incidence of SI and the functional outcome after SI, which was mostly due to intraoperative contamination and abdominal sepsis.
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Abstract: Shunt infection (SI) is an enduring problem in pediatric neurosurgery. Its occurrence is variable in the different series that were published, according to the definition retained. In addition, long-term data, which could help to evaluate the incidence of delayed SI, as well as the developmental outcome after SI, are scarce in the literature. We reviewed retrospectively children shunted for hydrocephalus during the last 20 years to evaluate the incidence of SI, including late SI, the risk factors and sources of contamination, and the late outcome after SI. We treated 1,173 patients who were followed-up for a mean duration of 7.0 years. During that period, 158 patients presented with a total number of 190 episodes of infection, 19 of which occurred more than 1 year after surgery. The infection rates per patient and per procedure were 13.6 and 5.9%, respectively. Age below 4 months at shunt insertion [odds ratio (OR)=1.81], antenatal diagnosis (OR=2.23), myelomeningocele (OR=2.14), and post-hemorrhagic hydrocephalus (OR=1.98) were significantly correlated with SI. SI was mostly due to intraoperative contamination; however, delayed SI was mostly caused by blood-borne contamination and abdominal sepsis. The mortality related to SI was 10.1%; the Glasgow Outcome Score, as well as schooling, was significantly and independently affected by SI. Long-term follow-up of shunted children is necessary to evaluate the real incidence of SI and the functional outcome after SI.
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Citations
Epidemiology, Diagnosis, and Antimicrobial Treatment of Acute Bacterial Meningitis
TL;DR: The changing epidemiology of bacterial meningitis in the United States and throughout the world is described by reviewing the global changes in etiological agents followed by specific microorganism data on the impact of the development and widespread use of conjugate vaccines.
2017 Infectious Diseases Society of America's Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis.
Allan R. Tunkel,Rodrigo Hasbun,Adarsh Bhimraj,Karin E. Byers,Sheldon L. Kaplan,W. Michael Scheld,Diederik van de Beek,Thomas P. Bleck,Hugh J. L. Garton,Joseph R. Zunt +9 more
TL;DR: These guidelines represent a practical and useful approach to assist practicing clinicians in the management of these challenging infections.
806
2017 Infectious Diseases Society of America's Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis.
Allan R. Tunkel,Rodrigo Hasbun,Adarsh Bhimraj,Karin E. Byers,Sheldon L. Kaplan,W. Scheld,Diederik van de Beek,Thomas P. Bleck,Hugh J. L. Garton,Joseph R. Zunt +9 more
TL;DR: These guidelines represent a practical and useful approach to assist practicing clinicians in the management of these challenging infections.
423
Nosocomial Bacterial Meningitis
TL;DR: Nosocomial bacterial meningitis is most often related to either complicated head trauma or invasive procedures, such as craniotomy, placement of ventricular catheters, intrathecal infusion of medications, or spinal anesthesia.
391
Infection rates following initial cerebrospinal fluid shunt placement across pediatric hospitals in the United States. Clinical article.
Tamara D. Simon,Matthew Hall,Jay Riva-Cambrin,J Elaine Albert,Howard E. Jeffries,Bonnie LaFleur,J. Michael Dean,John R. W. Kestle +7 more
TL;DR: In this paper, the authors determined the CSF shunt infection rates after initial shunt placement at multiple US pediatric hospitals and hypothesized that infection rates between hospitals would vary widely even after adjustment for patient, hospital, and surgeon factors.
References
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Alicia J. Mangram,Teresa C. Horan,Michele L. Pearson,Leah Christine Silver,William R. Jarvis +4 more
TL;DR: The guidelines for the prevention of surgical wound infections (SSI) were published by the Centers for Disease Control and Prevention (CDC) in 1999 as discussed by the authors, with the goal of reducing infectious complications associated with these procedures.
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Alicia J. Mangram,Teresa C. Horan,Michele L. Pearson,Leah Christine Silver,William R. Jarvis +4 more
TL;DR: The “Guideline for Prevention of Surgical Site Infection, 1999” presents the Centers for Disease Control and Prevention's recommendations for the prevention of surgical site infections (SSIs), formerly called surgical wound infections, and replaces previous guidelines.
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TL;DR: The nature of the neurological and mental disabilities resulting from severe head injuries are analysed and an extended version of the Glasgow Outcome Scale is described and compared with alternatives.
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Randomized trial of cerebrospinal fluid shunt valve design in pediatric hydrocephalus.
James M. Drake,John R. W. Kestle,Ruth Milner,Giuseppe Cinalli,Frederick A. Boop,Joseph H. Piatt,Stephen J. Haines,Steven J. Schiff,D. Douglas Cochrane,Paul Steinbok,Nancy MacNeil +10 more
TL;DR: Cerebrospinal fluid shunt failure, predominantly from shunt obstruction and infection, remains a persistent problem in pediatric hydrocephalus.
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TL;DR: A new protocol for shunt procedures involving modifications in the immediate pre-, intra- and postoperative management of children undergoing shunt implantation was initiated, and the incidence of shunt infection decreased dramatically.
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