Results From New Hydrocephalus Clinical Research Network Investigation Demonstrates Reductions in Shunt Infection Rates Attributable to Standardized Infection Prevention Protocol and Use of AICs and Vancomycin Irrigation

August 2, 2022

Member institutions of the Hydrocephalus Clinical Research Network (HCRN), including UPMC Children’s Hospital of Pittsburgh, published findings from their most recent investigation1 testing infection prevention protocols for shunt surgery.

Results were published in the June edition of the Journal of Neurosurgery: Pediatrics and the study was selected as one of the Editor's Choice features for the edition.

UPMC Children’s Ian F. Pollack, MD, FACS, FAAP, FAAN, chief of Pediatric Neurosurgery and site principal investigator contributed to the study.

Prior work by the HCRN on developing and validating a standardized shunt infection prevention protocol has been previously published in two papers detailing the early development of the protocol and its efficacy in preventing shunt infection.2,3

 In the most recent study continuing the quality improvement work on shunt infections, HCRN members examined the effects of the simplified 5-step infection prevention protocol in combination with antibiotic-impregnated catheters (AIC) and vancomycin irrigation (VI).

Study Findings and Clinical Significance in Brief

Through an analysis of 4,913 shunt surgeries performed at 13 sites of the HCRN between November 2016 and December 31, 2019, the investigators found a significant decrease in CSF shunt infection rates when the 5-step protocol was implemented in conjunction with both AIC and VI.

The overall infection rate in cases was found to be 5.1%, with nearly 80% of procedures (79.4%) in compliance with the entire 5-step infection prevention protocol. Infection rates for only the 5-step protocol were 8.1%.

However, when the use of AIC in conjunction with the protocol was examined, the infection rate was cut by nearly half, at 4.9% of cases. Furthermore, the use of vancomycin irrigation also conferred a statistically significant reduction in infection rates. Interestingly, when comparing vancomycin use with bacitracin, bacitracin use saw higher infection rates.

“These results clearly support the use of the 5-step protocol combined with AICs and vancomycin to stave off and reduce rates of shunt infection,” says Dr. Pollack.

Additionally, the research study was also powered to investigate potential nonmodifiable risk factors for shunt infection.

The investigation team found that patients with greater than or equal to 2 comorbid complex chronic conditions were at a significantly higher risk for shunt infection, as were patients who had undergone a previous shunt operation within 12 weeks of the most recent one.

“These findings are also of great clinical significance. While we may not be able to modify these factors directly, knowing they exist can help us plan our procedures more effectively and counsel patients and families about the risks," says Dr. Pollack. "For these cases, we will need heightened awareness and diligence to try and mitigate potential infections."

Learn more about the studies using the reference links below.

References

1. Chu J, Jensen H, Holubkov R, et al for the Hydrocephalus Clinical Research Network. The Hydrocephalus Clinical Research Network Quality Improvement Initiative: The Role of Antibiotic-Impregnated Catheters and Vancomycin Wound Irrigation. J Neurosurg Pediatr. 2022; 29: 711-718.

2. Kestle JR, Riva-Cambrin J, Wellons JC III, et al. A Standardized Protocol to Reduce Cerebrospinal Fluid Shunt Infection: The Hydrocephalus Clinical Research Network Quality Improvement Initiative. J Neurosurg Pediatr. 2011; 8(1): 22-29.

3. Kestle JR, Holubkov R, Cochrane D, et al. A New Hydrocephalus Clinical Research Network Protocol to Reduce Cerebrospinal Fluid Shunt Infection. J Neurosurg Pediatr. 2016; 17(4): 391-396.