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Evaluation of Pathogens in Shunt Infections Developed in Newborns Underwent Ventriculoperitoneal Shunt for Hydrocephaly

Year 2022, Volume: 75 Issue: 4, 570 - 575, 20.01.2023

Abstract

Objectives: The ventriculoperitoneal (VP) shunt is the most commonly used treatment modality in hydrocephaly. However, VP shunt infection is a common, severe complication with high mortality and morbidity rate. The aim of the study was to evaluate clinical characteristics, shunt infections and pathogen agents in newborns underwent VP shunt procedure for hydrocephaly.

Materials and Methods: This retrospective study was conducted in Neonatal Intensive Care Unit of Harran University, Faculty of Medicine between January, 2016 and June, 2021. The study included all newborns admitted with hydrocephaly and underwent VP shunt procedure.

Results: The study included 52 cases with hydrocephaly. Of the cases shunt infection plus meningitis was develop in 28 (53.8%) while no shunt infection plus meningitis was developed in 24 (46.2%). Of the cases developed shunt infection plus meningitis, 8 were boys (28.6%) and 20 were girls (71.4%). Of the cases with growth in culture tests, Gram-positive bacteria were detected in 5 (18.0%) whereas Gram-negative enteric and nonfermenter bacteria in 22 (78.4%) and Candida parapsilosis in one (3.6%).

Conclusion: In our study, we found that the incidence of Gram-negative bacterial infection was high. We believe that treatment with Gramnegative coverage will be appropriate until culture test results available when VP shunt infection is suspected.

Ethical Statement

Ethics Committee Approval: The study was approved by Ethics Committee of Harran University, Faculty of Medicine (approval date: 14.09.2017; approval no: 09-10). Informed Consent: In all patients, informed consent was obtained for anesthesia before surgery. Peer-reviewed: Externally peer-reviewed.

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Thanks

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References

  • 1. Fernell E, Hagberg G, Hagberg B. Infantile hydrocephalus epidemiology: an indicator of enhanced survival. Arch Dis Child Fetal Neonatal Ed. 1994;70:F123-F128.
  • 2. Telhan L, Çavuşoğlu F, Müslüman M, et al. Ventriküloperitoneal şant enfeksiyonu gelişmiş çocukların etiyolojik ve prognostik açılardan değerlendirilmesi. Çocuk Enf Derg. 2010;3:100-103.
  • 3. Glees P, Voth DJNr. Clinical and ultrastructural observations of maturing human frontal cortex. Part I (Biopsy material of hydrocephalic infants). Neurosurg Rev. 1988;11:273-278.
  • 4. Choux M, Genitori L, Lang D, et al. Shunt implantation: reducing the incidence of shunt infection. J Neurosurg. 1992;77:875-880.
  • 5. Zemack G, Romner B. Seven years of clinical experience with the programmable Codman Hakim valve: a retrospective study of 583 patients. J Neurosurg. 2000;92:941-948.
  • 6. Vanaclocha V, Saiz-Sapena N, Leiva J. Shunt malfunction in relation toshunt infection. Acta Neurochir (Wien). 1996;138:829-834.
  • 7. Piatt Jr JH, Carlson CV. A search for determinants of cerebrospinal fluid shunt survival: retrospective analysis of a 14-year institutional experience. Pediatr Neurosurg. 1993;19:233-242.
  • 8. Ammirati M, Raimondi AJ. Cerebrospinal fluid shunt infections in children. Childs Nerv Syst. 1987;3:106-109.
  • 9. Davis SE, Levy ML, McComb JG, et al. Does age or other factors influence the incidence of ventriculoperitoneal shunt infections? Pediatr Neurosurg. 1999;30:253-257.
  • 10. Kanik A, Sirin S, Kose E, et al. Clinical and economic results of ventriculoperitoneal shunt infections in children. Turk Neurosurg. 2015;25:58-62.
  • 11. Furyk JS, Swann O, Molyneux E. Systematic review: neonatal meningitis in the developing world. Trop Med Int Health. 2011;16:672-679.
  • 12. Bhat S, Naik S, Rafiq W, et al. Incidence of thrombocytopenia and changes in various platelet parameters, in blood culture positive neonatal sepsis. Int J Pediatr. 2015;3:757-766.
  • 13. Odio C, McCracken GH, Nelson JDJAjodoc. CSF shunt infections in pediatrics: a seven-year experience. Am J Dis Child. 1984;138:1103-1108.
  • 14. Pirotte BJ, Lubansu A, Bruneau M, et al. Sterile surgical technique for shunt placement reduces the shunt infection rate in children: preliminary analysisof a prospective protocol in 115 consecutive procedures. Childs Nerv Syst. 2007;23:1251-1261.
  • 15. Kestle JR, Riva-Cambrin J, Wellons JC, et al. A standardized protocol to reduce cerebrospinal fluid shunt infection: the Hydrocephalus Clinical Research Network Quality Improvement Initiative. J Neurosurg Pediatr.2011;8:22-29.
  • 16. Vinchon M, Dhellemmes P. Cerebrospinal fluid shunt infection: risk factors and long-term follow-up. Childs Nerv Syst. 2006;22:692-697.
  • 17. Etches PC, Ward TF, Bhui PS, et al. Outcome of shunted posthemorrhagic hydrocephalus in premature infants. Pediatr Neurol. 1987;3:136-140.
  • 18. Köksal V, Öktem S. Ventriculosubgaleal shunt procedure and its long-termoutcomes in premature infants with post-hemorrhagic hydrocephalus. Childs Nerv Syst. 2010;26:1505-1515.
  • 19. Gündeşlioğlu ÖÖ, Haytaoğlu Z, Özsoy KM, et al. Ventriculoperitoneal Shunt Infections in Children: Demographical, Clinical Findings and Evaluation ofThrombocyte Parameters. J Pediatr Inf. 2018;12:e63-e69
  • 20. Aryan HE, Meltzer HS, Park MS, et al. Initial experience with antibioticimpregnated silicone catheters for shunting of cerebrospinal fluid in children. Childs Nerv Syst. 2005;21:56-61.
  • 21. Eymann R, Steudel W-I, Kiefer M. Infection rate with application of an antibiotic-impregnated catheter for shunt implantation in children–a retrospective analysis. Klin Padiatr. 2009;221:69-73.
  • 22. Yakut N, Soysal A, Kepenekli Kadayifci E, et al. Ventriculoperitoneal shunt infections and re-infections in children: a multicentre retrospective study. Br J Neurosurg. 2018;32:196-200.
  • 23. Conen A, Walti LN, Merlo A, et al. Characteristics and treatment outcome of cerebrospinal fluid shunt-associated infections in adults: a retrospective analysis over an 11-year period. Clin Infect Dis. 2008;47:73-82.
  • 24. Lee JK, Seok JY, Lee JH, et al. Incidence and risk factors of ventriculoperitoneal shunt infections in children: a study of 333 consecutive shunts in 6 years. J Korean Med Sci. 2012;27:1563-1568.
  • 25. McGirt MJ, Zaas A, Fuchs HE, et al. Risk factors for pediatric ventriculoperitoneal shunt infection and predictors of infectious pathogens. Clin Infect Dis. 2003;36:858-862.
  • 26. Isla Guerrero A, Peña García P, Ortega V, et al. [Antibiotic therapy of infected cerebrospinal fluid in hydrocephalus treated by a shunt]. An Esp Pediatr. 1988;29:435-439.
  • 27. Parker SL, Attenello FJ, Sciubba DM, et al. Comparison of shunt infection incidence in high-risk subgroups receiving antibiotic-impregnated versus standard shunts. Childs Nerv Syst. 2009;25:77-83.
  • 28. Lai MY, Tsai MH, Lee CW, et al. Characteristics of neonates with cultureproven bloodstream infection who have low levels of C-reactive protein (≤ 10 mg/L). BMC Infect Dis. 2015;15:1-9.
  • 29. Gümüş H, Kazanasmaz H. The investigation of risk factors, laboratory findings, mortality rates and antibiotic resistance of Klebsiella pneumoniae sepsis in neonatal intensive care unit. Journal of Harran University Medical Faculty. 2018;15:140-144.
  • 30. Ree IM, Fustolo-Gunnink SF, Bekker V, et al. Thrombocytopenia in neonatal sepsis: Incidence, severity and risk factors. PLoS One. 2017;12:e0185581. 31. Makhoul IR, Kassis I, Smolkin T, et al. Review of 49 neonates with acquired fungal sepsis: further characterization. Pediatrics. 2001;107:61-66.

Hidrosefali Tanısı ile Ventriküloperitoneal Şant Takılan Yenidoğan Hastalarda Gelişen Şant Enfeksiyon Etkenlerinin Araştırılması

Year 2022, Volume: 75 Issue: 4, 570 - 575, 20.01.2023

Abstract

Amaç: Ventriküloperitoneal (VP) şant, hidrosefali için en yaygın tedavi yöntemidir. Bununla birlikte, VP şant enfeksiyonu, yüksek mortalite ve morbidite oranları ile yaygın ve ciddi bir komplikasyondur. Bu çalışmanın amacı, hidrosefali nedeni ile takip edilen ve VP şant takılan neonatal hidrosefali olgularının klinik özellikleri, gelişen şant enfeksiyonları ve enfeksiyon etkenleri açısından değerlendirmektir.

Gereç ve Yöntem: Bu çalışma, retrospektif olarak, 2016 Ocak-2021 Haziran tarihleri arasında, 3. basamak bir hastane olan Harran Üniversitesi Tıp Fakültesi Yenidoğan Yoğun Bakım Ünitesi’nde gerçekleştirildi. Çalışmaya hidrosefali tanısı ile yatan ve VP şant takılan tüm yenidoğanlar dahil edildi.

Bulgular: Çalışmaya hidrosefali tanılı 52 olgu dahil edildi. Olguların 28‘inde (%53,8) şant enfeksiyonu+menenjit gelişirken, olguların 24’ünde (%46,2) şant enfeksiyonu+menenjit gelişmedi. Şant enfeksiyonu+menenjit gelişen olguların 8 erkek (%28,6), 20 kız (%71,4) bebek olduğu görüldü. Kültürde üreme tespit edilen olguların 5’inde (%18) Gram-pozitif bakteriler ve 22’sinde (%78,4) Gram-negatif enterik ve non-fermenter bakteriler, 1’inde (%3,6) Candida parapsilozis saptandı.

Sonuç: Çalışmamızda Gram-negatif bakteriyel enfeksiyon insidansının yüksek olduğunu tespit ettik. VP şant enfeksiyonu düşünüldüğü durumlarda kültür sonucu çıkana kadar Gram-negatif etkenlere yönelik tedavi başlanmasının uygun olacağını düşünmekteyiz.

Ethical Statement

-

Supporting Institution

-

Project Number

-

Thanks

-

References

  • 1. Fernell E, Hagberg G, Hagberg B. Infantile hydrocephalus epidemiology: an indicator of enhanced survival. Arch Dis Child Fetal Neonatal Ed. 1994;70:F123-F128.
  • 2. Telhan L, Çavuşoğlu F, Müslüman M, et al. Ventriküloperitoneal şant enfeksiyonu gelişmiş çocukların etiyolojik ve prognostik açılardan değerlendirilmesi. Çocuk Enf Derg. 2010;3:100-103.
  • 3. Glees P, Voth DJNr. Clinical and ultrastructural observations of maturing human frontal cortex. Part I (Biopsy material of hydrocephalic infants). Neurosurg Rev. 1988;11:273-278.
  • 4. Choux M, Genitori L, Lang D, et al. Shunt implantation: reducing the incidence of shunt infection. J Neurosurg. 1992;77:875-880.
  • 5. Zemack G, Romner B. Seven years of clinical experience with the programmable Codman Hakim valve: a retrospective study of 583 patients. J Neurosurg. 2000;92:941-948.
  • 6. Vanaclocha V, Saiz-Sapena N, Leiva J. Shunt malfunction in relation toshunt infection. Acta Neurochir (Wien). 1996;138:829-834.
  • 7. Piatt Jr JH, Carlson CV. A search for determinants of cerebrospinal fluid shunt survival: retrospective analysis of a 14-year institutional experience. Pediatr Neurosurg. 1993;19:233-242.
  • 8. Ammirati M, Raimondi AJ. Cerebrospinal fluid shunt infections in children. Childs Nerv Syst. 1987;3:106-109.
  • 9. Davis SE, Levy ML, McComb JG, et al. Does age or other factors influence the incidence of ventriculoperitoneal shunt infections? Pediatr Neurosurg. 1999;30:253-257.
  • 10. Kanik A, Sirin S, Kose E, et al. Clinical and economic results of ventriculoperitoneal shunt infections in children. Turk Neurosurg. 2015;25:58-62.
  • 11. Furyk JS, Swann O, Molyneux E. Systematic review: neonatal meningitis in the developing world. Trop Med Int Health. 2011;16:672-679.
  • 12. Bhat S, Naik S, Rafiq W, et al. Incidence of thrombocytopenia and changes in various platelet parameters, in blood culture positive neonatal sepsis. Int J Pediatr. 2015;3:757-766.
  • 13. Odio C, McCracken GH, Nelson JDJAjodoc. CSF shunt infections in pediatrics: a seven-year experience. Am J Dis Child. 1984;138:1103-1108.
  • 14. Pirotte BJ, Lubansu A, Bruneau M, et al. Sterile surgical technique for shunt placement reduces the shunt infection rate in children: preliminary analysisof a prospective protocol in 115 consecutive procedures. Childs Nerv Syst. 2007;23:1251-1261.
  • 15. Kestle JR, Riva-Cambrin J, Wellons JC, et al. A standardized protocol to reduce cerebrospinal fluid shunt infection: the Hydrocephalus Clinical Research Network Quality Improvement Initiative. J Neurosurg Pediatr.2011;8:22-29.
  • 16. Vinchon M, Dhellemmes P. Cerebrospinal fluid shunt infection: risk factors and long-term follow-up. Childs Nerv Syst. 2006;22:692-697.
  • 17. Etches PC, Ward TF, Bhui PS, et al. Outcome of shunted posthemorrhagic hydrocephalus in premature infants. Pediatr Neurol. 1987;3:136-140.
  • 18. Köksal V, Öktem S. Ventriculosubgaleal shunt procedure and its long-termoutcomes in premature infants with post-hemorrhagic hydrocephalus. Childs Nerv Syst. 2010;26:1505-1515.
  • 19. Gündeşlioğlu ÖÖ, Haytaoğlu Z, Özsoy KM, et al. Ventriculoperitoneal Shunt Infections in Children: Demographical, Clinical Findings and Evaluation ofThrombocyte Parameters. J Pediatr Inf. 2018;12:e63-e69
  • 20. Aryan HE, Meltzer HS, Park MS, et al. Initial experience with antibioticimpregnated silicone catheters for shunting of cerebrospinal fluid in children. Childs Nerv Syst. 2005;21:56-61.
  • 21. Eymann R, Steudel W-I, Kiefer M. Infection rate with application of an antibiotic-impregnated catheter for shunt implantation in children–a retrospective analysis. Klin Padiatr. 2009;221:69-73.
  • 22. Yakut N, Soysal A, Kepenekli Kadayifci E, et al. Ventriculoperitoneal shunt infections and re-infections in children: a multicentre retrospective study. Br J Neurosurg. 2018;32:196-200.
  • 23. Conen A, Walti LN, Merlo A, et al. Characteristics and treatment outcome of cerebrospinal fluid shunt-associated infections in adults: a retrospective analysis over an 11-year period. Clin Infect Dis. 2008;47:73-82.
  • 24. Lee JK, Seok JY, Lee JH, et al. Incidence and risk factors of ventriculoperitoneal shunt infections in children: a study of 333 consecutive shunts in 6 years. J Korean Med Sci. 2012;27:1563-1568.
  • 25. McGirt MJ, Zaas A, Fuchs HE, et al. Risk factors for pediatric ventriculoperitoneal shunt infection and predictors of infectious pathogens. Clin Infect Dis. 2003;36:858-862.
  • 26. Isla Guerrero A, Peña García P, Ortega V, et al. [Antibiotic therapy of infected cerebrospinal fluid in hydrocephalus treated by a shunt]. An Esp Pediatr. 1988;29:435-439.
  • 27. Parker SL, Attenello FJ, Sciubba DM, et al. Comparison of shunt infection incidence in high-risk subgroups receiving antibiotic-impregnated versus standard shunts. Childs Nerv Syst. 2009;25:77-83.
  • 28. Lai MY, Tsai MH, Lee CW, et al. Characteristics of neonates with cultureproven bloodstream infection who have low levels of C-reactive protein (≤ 10 mg/L). BMC Infect Dis. 2015;15:1-9.
  • 29. Gümüş H, Kazanasmaz H. The investigation of risk factors, laboratory findings, mortality rates and antibiotic resistance of Klebsiella pneumoniae sepsis in neonatal intensive care unit. Journal of Harran University Medical Faculty. 2018;15:140-144.
  • 30. Ree IM, Fustolo-Gunnink SF, Bekker V, et al. Thrombocytopenia in neonatal sepsis: Incidence, severity and risk factors. PLoS One. 2017;12:e0185581. 31. Makhoul IR, Kassis I, Smolkin T, et al. Review of 49 neonates with acquired fungal sepsis: further characterization. Pediatrics. 2001;107:61-66.
There are 30 citations in total.

Details

Primary Language English
Subjects Pediatric Infectious Diseases
Journal Section Articles
Authors

Nurgül Ataş 0000-0002-7230-0497

Project Number -
Publication Date January 20, 2023
Published in Issue Year 2022 Volume: 75 Issue: 4

Cite

APA Ataş, N. (2023). Evaluation of Pathogens in Shunt Infections Developed in Newborns Underwent Ventriculoperitoneal Shunt for Hydrocephaly. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 75(4), 570-575. https://doi.org/10.4274/atfm.galenos.2023.96977
AMA Ataş N. Evaluation of Pathogens in Shunt Infections Developed in Newborns Underwent Ventriculoperitoneal Shunt for Hydrocephaly. Ankara Üniversitesi Tıp Fakültesi Mecmuası. January 2023;75(4):570-575. doi:10.4274/atfm.galenos.2023.96977
Chicago Ataş, Nurgül. “Evaluation of Pathogens in Shunt Infections Developed in Newborns Underwent Ventriculoperitoneal Shunt for Hydrocephaly”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 75, no. 4 (January 2023): 570-75. https://doi.org/10.4274/atfm.galenos.2023.96977.
EndNote Ataş N (January 1, 2023) Evaluation of Pathogens in Shunt Infections Developed in Newborns Underwent Ventriculoperitoneal Shunt for Hydrocephaly. Ankara Üniversitesi Tıp Fakültesi Mecmuası 75 4 570–575.
IEEE N. Ataş, “Evaluation of Pathogens in Shunt Infections Developed in Newborns Underwent Ventriculoperitoneal Shunt for Hydrocephaly”, Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 75, no. 4, pp. 570–575, 2023, doi: 10.4274/atfm.galenos.2023.96977.
ISNAD Ataş, Nurgül. “Evaluation of Pathogens in Shunt Infections Developed in Newborns Underwent Ventriculoperitoneal Shunt for Hydrocephaly”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 75/4 (January2023), 570-575. https://doi.org/10.4274/atfm.galenos.2023.96977.
JAMA Ataş N. Evaluation of Pathogens in Shunt Infections Developed in Newborns Underwent Ventriculoperitoneal Shunt for Hydrocephaly. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2023;75:570–575.
MLA Ataş, Nurgül. “Evaluation of Pathogens in Shunt Infections Developed in Newborns Underwent Ventriculoperitoneal Shunt for Hydrocephaly”. Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 75, no. 4, 2023, pp. 570-5, doi:10.4274/atfm.galenos.2023.96977.
Vancouver Ataş N. Evaluation of Pathogens in Shunt Infections Developed in Newborns Underwent Ventriculoperitoneal Shunt for Hydrocephaly. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2023;75(4):570-5.