The following is a summary of “Antibiotic-impregnated catheters and intrathecal antibiotics for CSF shunt infection prevention in children undergoing low-risk CSF shunt surgery,” published in the May 2024 issue of Pediatrics by Podkovik et al.

Cerebrospinal fluid (CSF) shunting procedures are vital for the survival and neurological well-being of children with hydrocephalus, preventing brain injury and associated complications. The Hydrocephalus Clinical Research Network has implemented quality improvement protocols to reduce infection rates in these patients. Initially, intrathecal (IT) antibiotics were introduced between 2007 and 2009, followed by the adoption of antibiotic-impregnated catheters (AIC) in 2012–2013. However, there is a notable gap in large-scale studies comparing infection prevention efficacy between these techniques in pediatric populations. Therefore, the study sought to address this gap by comparing the risk of infection following the use of IT antibiotics, AIC, and standard care during low-risk CSF shunt surgeries, including initial placement and revisions, in children.

The retrospective observational cohort study collected data from six tertiary care children’s hospitals using the Pediatric Health Information System + (PHIS+) database, supplemented by manual chart review. Researchers focused on children aged 18 years or younger who underwent initial shunt placement between January 2007 and December 2012, with infection and subsequent CSF shunt surgery data collected through December 2015. Propensity score adjustment for regression analysis was conducted based on site, procedure type, and year, with the surgeon treated as a random effect.

The analysis included 1,723 children who underwent initial shunt placement during the specified period, 1,371 subsequent shunt revisions, and 138 cases of shunt infections. Propensity-adjusted regression analysis revealed no statistically significant difference in the odds of shunt infection between IT antibiotics (OR 1.22, 95% CI 0.82–1.81, p = 0.3) and AIC (OR 0.91, 95% CI 0.56–1.49, p = 0.7) compared to standard care.

In conclusion, the findings from a large, multicenter observational cohort suggest that neither IT antibiotics nor AIC provide a statistically significant risk reduction compared to standard care for pediatric patients undergoing low-risk CSF shunt surgeries, including initial placement and revisions.

Source: bmcpediatr.biomedcentral.com/articles/10.1186/s12887-024-04798-9