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Article: Primary ventriculoperitoneal shunting outcomes: A multicentre clinical audit for shunt infection and its risk factors

TitlePrimary ventriculoperitoneal shunting outcomes: A multicentre clinical audit for shunt infection and its risk factors
Authors
Issue Date2016
Citation
Hong Kong Medical Journal, 2016, v. 22, n. 5, p. 410-419 How to Cite?
AbstractObjectives: To determine the frequency of primary ventriculoperitoneal shunt infection among patients treated at neurosurgical centres of the Hospital Authority and to identify underlying risk factors. Methods: This multicentre historical cohort study included consecutive patients who underwent primary ventriculoperitoneal shunting at a Hospital Authority neurosurgery centre from 1 January 2009 to 31 December 2011. The primary endpoint was shunt infection, defined as: (1) the presence of cerebrospinal fluid or shunt hardware culture that yielded the pathogenic micro-organism with associated compatible symptoms and signs of central nervous system infection or shunt malfunction; or (2) surgical incision site infection requiring shunt reinsertion (even in the absence of positive culture); or (3) intraperitoneal pseudocyst formation (even in the absence of positive culture). Secondary endpoints were shunt malfunction, defined as unsatisfactory cerebrospinal fluid drainage that required shunt reinsertion, and 30-day mortality. Results: A primary ventriculoperitoneal shunt was inserted in 538 patients during the study period. The mean age of patients was 48 years (range, 13-88 years) with a male-to-female ratio of 1:1. Aneurysmal subarachnoid haemorrhage was the most common aetiology (n=169, 31%) followed by intracranial tumour (n=164, 30%), central nervous system infection (n=42, 8%), and traumatic brain injury (n=27, 5%). The mean operating time was 75 (standard deviation, 29) minutes. Shunt reinsertion and infection rates were 16% (n=87) and 7% (n=36), respectively. The most common cause for shunt reinsertion was malfunction followed by shunt infection. Independent predictors for shunt infection were: traumatic brain injury (adjusted odds ratio=6.2; 95% confidence interval, 2.3-16.8), emergency shunting (2.3; 1.0-5.1), and prophylactic vancomycin as the sole antibiotic (3.4; 1.1-11.0). The 30-day all-cause mortality was 6% and none were directly procedure-related. Conclusions: This is the first Hong Kong territorywide review of infection in primary ventriculoperitoneal shunts. Although the ventriculoperitoneal shunt infection rate met international standards, there are areas of improvement such as vancomycin administration and the avoidance of scheduling the procedure as an emergency.
Persistent Identifierhttp://hdl.handle.net/10722/325331
ISSN
2023 Impact Factor: 3.1
2023 SCImago Journal Rankings: 0.261
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorWoo, Peter Y.M.-
dc.contributor.authorWong, H. T.-
dc.contributor.authorPu, Jenny K.S.-
dc.contributor.authorWong, W. K.-
dc.contributor.authorWong, Larry Y.W.-
dc.contributor.authorLee, Michael W.Y.-
dc.contributor.authorYam, K. Y.-
dc.contributor.authorLui, W. M.-
dc.contributor.authorPoon, W. S.-
dc.date.accessioned2023-02-27T07:31:37Z-
dc.date.available2023-02-27T07:31:37Z-
dc.date.issued2016-
dc.identifier.citationHong Kong Medical Journal, 2016, v. 22, n. 5, p. 410-419-
dc.identifier.issn1024-2708-
dc.identifier.urihttp://hdl.handle.net/10722/325331-
dc.description.abstractObjectives: To determine the frequency of primary ventriculoperitoneal shunt infection among patients treated at neurosurgical centres of the Hospital Authority and to identify underlying risk factors. Methods: This multicentre historical cohort study included consecutive patients who underwent primary ventriculoperitoneal shunting at a Hospital Authority neurosurgery centre from 1 January 2009 to 31 December 2011. The primary endpoint was shunt infection, defined as: (1) the presence of cerebrospinal fluid or shunt hardware culture that yielded the pathogenic micro-organism with associated compatible symptoms and signs of central nervous system infection or shunt malfunction; or (2) surgical incision site infection requiring shunt reinsertion (even in the absence of positive culture); or (3) intraperitoneal pseudocyst formation (even in the absence of positive culture). Secondary endpoints were shunt malfunction, defined as unsatisfactory cerebrospinal fluid drainage that required shunt reinsertion, and 30-day mortality. Results: A primary ventriculoperitoneal shunt was inserted in 538 patients during the study period. The mean age of patients was 48 years (range, 13-88 years) with a male-to-female ratio of 1:1. Aneurysmal subarachnoid haemorrhage was the most common aetiology (n=169, 31%) followed by intracranial tumour (n=164, 30%), central nervous system infection (n=42, 8%), and traumatic brain injury (n=27, 5%). The mean operating time was 75 (standard deviation, 29) minutes. Shunt reinsertion and infection rates were 16% (n=87) and 7% (n=36), respectively. The most common cause for shunt reinsertion was malfunction followed by shunt infection. Independent predictors for shunt infection were: traumatic brain injury (adjusted odds ratio=6.2; 95% confidence interval, 2.3-16.8), emergency shunting (2.3; 1.0-5.1), and prophylactic vancomycin as the sole antibiotic (3.4; 1.1-11.0). The 30-day all-cause mortality was 6% and none were directly procedure-related. Conclusions: This is the first Hong Kong territorywide review of infection in primary ventriculoperitoneal shunts. Although the ventriculoperitoneal shunt infection rate met international standards, there are areas of improvement such as vancomycin administration and the avoidance of scheduling the procedure as an emergency.-
dc.languageeng-
dc.relation.ispartofHong Kong Medical Journal-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.titlePrimary ventriculoperitoneal shunting outcomes: A multicentre clinical audit for shunt infection and its risk factors-
dc.typeArticle-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.12809/hkmj154735-
dc.identifier.pmid27562986-
dc.identifier.scopuseid_2-s2.0-84990924627-
dc.identifier.volume22-
dc.identifier.issue5-
dc.identifier.spage410-
dc.identifier.epage419-
dc.identifier.isiWOS:000384960300002-

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