Tamara D Simon1, Matthew P Kronman2, Kathryn B Whitlock3, Nancy Gove3, Samuel R Browd4, Richard Holubkov5, John R W Kestle6, Abhaya V Kulkarni7, Marcie Langley6, David D Limbrick8, Thomas G Luerssen9, Jerry Oakes10, Jay Riva-Cambrin6, Curtis Rozzelle10, Chevis Shannon10, Mandeep Tamber11, John C Wellons10, William E Whitehead9, Nicole Mayer-Hamblett2. 1. Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, WA; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA. Electronic address: Tamara.Simon@seattlechildrens.org. 2. Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, WA; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA. 3. Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA. 4. Department of Neurosurgery, University of Washington/Seattle Children's Hospital, Seattle, WA. 5. Department of Pediatrics, University of Utah, Salt Lake City, UT. 6. Division of Pediatric Neurosurgery, Primary Children's Medical Center, Department of Neurosurgery, University of Utah, Salt Lake City, UT. 7. Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Toronto, Canada. 8. Department of Neurosurgery, St. Louis Children's Hospital, Washington University in Saint Louis, St. Louis, MO. 9. Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, TX. 10. Section of Pediatric Neurosurgery, Children's Hospital of Alabama, Division of Neurosurgery, University of Alabama - Birmingham, Birmingham, AL. 11. Division of Neurosurgery, Children's Hospital of Pittsburgh, Pittsburgh, PA.
Abstract
OBJECTIVES: To describe the variation in approaches to surgical and antibiotic treatment for first cerebrospinal fluid (CSF) shunt infection and adherence to Infectious Diseases Society of America (IDSA) guidelines. STUDY DESIGN: We conducted a prospective cohort study of children undergoing treatment for first CSF infection at 7 Hydrocephalus Clinical Research Network hospitals from April 2008 through December 2012. Univariate analyses were performed to describe the study population. RESULTS: A total of 151 children underwent treatment for first CSF shunt-related infection. Most children had undergone initial CSF shunt placement before the age of 6 months (n = 98, 65%). Median time to infection after shunt surgery was 28 days (IQR 15-52 days). Surgical management was most often shunt removal with interim external ventricular drain placement, followed by new shunt insertion (n = 122, 81%). Median time from first negative CSF culture to final surgical procedure was 14 days (IQR 10-21 days). Median duration of intravenous (IV) antibiotic use duration was 19 days (IQR 12-28 days). For 84 infections addressed by IDSA guidelines, 7 (8%) met guidelines and 61 (73%) had longer duration of IV antibiotic use than recommended. CONCLUSIONS: Surgical treatment for infection frequently adheres to IDSA guidelines of shunt removal with external ventricular drain placement followed by new shunt insertion. However, duration of IV antibiotic use in CSF shunt infection treatment was consistently longer than recommended by the 2004 IDSA guidelines.
OBJECTIVES: To describe the variation in approaches to surgical and antibiotic treatment for first cerebrospinal fluid (CSF) shunt infection and adherence to Infectious Diseases Society of America (IDSA) guidelines. STUDY DESIGN: We conducted a prospective cohort study of children undergoing treatment for first CSFinfection at 7 Hydrocephalus Clinical Research Network hospitals from April 2008 through December 2012. Univariate analyses were performed to describe the study population. RESULTS: A total of 151 children underwent treatment for first CSF shunt-related infection. Most children had undergone initial CSF shunt placement before the age of 6 months (n = 98, 65%). Median time to infection after shunt surgery was 28 days (IQR 15-52 days). Surgical management was most often shunt removal with interim external ventricular drain placement, followed by new shunt insertion (n = 122, 81%). Median time from first negative CSF culture to final surgical procedure was 14 days (IQR 10-21 days). Median duration of intravenous (IV) antibiotic use duration was 19 days (IQR 12-28 days). For 84 infections addressed by IDSA guidelines, 7 (8%) met guidelines and 61 (73%) had longer duration of IV antibiotic use than recommended. CONCLUSIONS: Surgical treatment for infection frequently adheres to IDSA guidelines of shunt removal with external ventricular drain placement followed by new shunt insertion. However, duration of IV antibiotic use in CSF shunt infection treatment was consistently longer than recommended by the 2004 IDSA guidelines.
Authors: Tamara D Simon; Kathryn B Whitlock; Jay Riva-Cambrin; John R W Kestle; Margaret Rosenfeld; J Michael Dean; Richard Holubkov; Marcie Langley; Nicole Mayer-Hamblett Journal: J Neurosurg Pediatr Date: 2012-01 Impact factor: 2.375
Authors: Michael A Williams; James P McAllister; Marion L Walker; Dory A Kranz; Marvin Bergsneider; Marc R Del Bigio; Laurel Fleming; David M Frim; Katrina Gwinn; John R W Kestle; Mark G Luciano; Joseph R Madsen; Mary Lou Oster-Granite; Giovanna Spinella Journal: J Neurosurg Date: 2007-11 Impact factor: 5.115
Authors: Tamara D Simon; Kathryn B Whitlock; Jay Riva-Cambrin; John R W Kestle; Margaret Rosenfeld; J Michael Dean; Richard Holubkov; Marcie Langley; Nicole Mayer Hamblett Journal: Pediatr Infect Dis J Date: 2012-06 Impact factor: 2.129
Authors: Rowland H Han; Andrew McKinnon; Travis S CreveCoeur; Brandon S Baksh; Amit M Mathur; Christopher D Smyser; Jennifer M Strahle; Margaret A Olsen; David D Limbrick Journal: Childs Nerv Syst Date: 2018-07-09 Impact factor: 1.475
Authors: Tamara D Simon; Matthew P Kronman; Kathryn B Whitlock; Nancy E Gove; Nicole Mayer-Hamblett; Samuel R Browd; D Douglas Cochrane; Richard Holubkov; Abhaya V Kulkarni; Marcie Langley; David D Limbrick; Thomas G Luerssen; W Jerry Oakes; Jay Riva-Cambrin; Curtis Rozzelle; Chevis Shannon; Mandeep Tamber; John C Wellons; William E Whitehead; John R W Kestle Journal: J Neurosurg Pediatr Date: 2018-02-02 Impact factor: 2.375
Authors: Tamara D Simon; Matthew P Kronman; Kathryn B Whitlock; Samuel R Browd; Richard Holubkov; John R W Kestle; Abhaya V Kulkarni; Marcie Langley; David D Limbrick; Thomas G Luerssen; Jerry Oakes; Jay Riva-Cambrin; Curtis Rozzelle; Chevis N Shannon; Mandeep Tamber; John C Wellons Iii; William E Whitehead; Nicole Mayer-Hamblett Journal: J Pediatric Infect Dis Soc Date: 2019-07-01 Impact factor: 3.164