Tamara D Simon1,2, Matthew P Kronman1,2, Kathryn B Whitlock2, Samuel R Browd3, Richard Holubkov4, John R W Kestle5, Abhaya V Kulkarni6, Marcie Langley5, David D Limbrick7, Thomas G Luerssen8, Jerry Oakes9, Jay Riva-Cambrin5, Curtis Rozzelle9, Chevis N Shannon9, Mandeep Tamber10, John C Wellons Iii9, William E Whitehead8, Nicole Mayer-Hamblett1,3. 1. Department of Pediatrics, University of Washington/Seattle Children's Hospital, Washington. 2. Seattle Children's Research Institute, Washington. 3. Department of Neurosurgery, University of Washington/Seattle Children's Hospital, Washington. 4. Department of Pediatrics, University of Utah, Salt Lake City. 5. Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Utah, Salt Lake City. 6. Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Canada. 7. Department of Neurosurgery, St. Louis Children's Hospital, Washington University in St. Louis, Missouri. 8. Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston. 9. Section of Pediatric Neurosurgery, Children's Hospital of Alabama, Division of Neurosurgery, University of Alabama - Birmingham. 10. Division of Neurosurgery, Children's Hospital of Pittsburgh, Pennsylvania.
Abstract
BACKGROUND: Previous studies of cerebrospinal fluid (CSF) shunt infection treatment have been limited in size and unable to compare patient and treatment characteristics by infecting organism. Our objective was to describe variation in patient and treatment characteristics for children with first CSF shunt infection, stratified by infecting organism subgroups outlined in the 2017 Infectious Disease Society of America's (IDSA) guidelines. METHODS: We studied a prospective cohort of children <18 years of age undergoing treatment for first CSF shunt infection at one of 7 Hydrocephalus Clinical Research Network hospitals from April 2008 to December 2012. Differences between infecting organism subgroups were described using univariate analyses and Fisher's exact tests. RESULTS: There were 145 children whose infections were diagnosed by CSF culture and addressed by IDSA guidelines, including 47 with Staphylococcus aureus, 52 with coagulase-negative Staphylococcus, 37 with Gram-negative bacilli, and 9 with Propionibacterium acnes. No differences in many patient and treatment characteristics were seen between infecting organism subgroups, including age at initial shunt, gender, race, insurance, indication for shunt, gastrostomy, tracheostomy, ultrasound, and/or endoscope use at all surgeries before infection, or numbers of revisions before infection. A larger proportion of infections were caused by Gram-negative bacilli when antibiotic-impregnated catheters were used at initial shunt placement (12 of 23, 52%) and/or subsequent revisions (11 of 23, 48%) compared with all other infections (9 of 68 [13%] and 13 of 68 [19%], respectively). No differences in reinfection were observed between infecting organism subgroups. CONCLUSIONS: The organism profile encountered at infection differs when antibiotic-impregnated catheters are used, with a higher proportion of Gram-negative bacilli. This warrants further investigation given increasing adoption of antibiotic-impregnated catheters.
BACKGROUND: Previous studies of cerebrospinal fluid (CSF) shunt infection treatment have been limited in size and unable to compare patient and treatment characteristics by infecting organism. Our objective was to describe variation in patient and treatment characteristics for children with first CSF shunt infection, stratified by infecting organism subgroups outlined in the 2017 Infectious Disease Society of America's (IDSA) guidelines. METHODS: We studied a prospective cohort of children <18 years of age undergoing treatment for first CSF shunt infection at one of 7 Hydrocephalus Clinical Research Network hospitals from April 2008 to December 2012. Differences between infecting organism subgroups were described using univariate analyses and Fisher's exact tests. RESULTS: There were 145 children whose infections were diagnosed by CSF culture and addressed by IDSA guidelines, including 47 with Staphylococcus aureus, 52 with coagulase-negative Staphylococcus, 37 with Gram-negative bacilli, and 9 with Propionibacterium acnes. No differences in many patient and treatment characteristics were seen between infecting organism subgroups, including age at initial shunt, gender, race, insurance, indication for shunt, gastrostomy, tracheostomy, ultrasound, and/or endoscope use at all surgeries before infection, or numbers of revisions before infection. A larger proportion of infections were caused by Gram-negative bacilli when antibiotic-impregnated catheters were used at initial shunt placement (12 of 23, 52%) and/or subsequent revisions (11 of 23, 48%) compared with all other infections (9 of 68 [13%] and 13 of 68 [19%], respectively). No differences in reinfection were observed between infecting organism subgroups. CONCLUSIONS: The organism profile encountered at infection differs when antibiotic-impregnated catheters are used, with a higher proportion of Gram-negative bacilli. This warrants further investigation given increasing adoption of antibiotic-impregnated catheters.
Authors: Tamara D Simon; Nicole Mayer-Hamblett; Kathryn B Whitlock; Marcie Langley; John R W Kestle; Jay Riva-Cambrin; Margaret Rosenfeld; Emily A Thorell Journal: J Pediatric Infect Dis Soc Date: 2013-08-26 Impact factor: 3.164
Authors: John R W Kestle; Richard Holubkov; D Douglas Cochrane; Abhaya V Kulkarni; David D Limbrick; Thomas G Luerssen; W Jerry Oakes; Jay Riva-Cambrin; Curtis Rozzelle; Tamara D Simon; Marion L Walker; John C Wellons; Samuel R Browd; James M Drake; Chevis N Shannon; Mandeep S Tamber; William E Whitehead Journal: J Neurosurg Pediatr Date: 2015-12-18 Impact factor: 2.375
Authors: Tamara D Simon; Matthew Hall; J Michael Dean; John R W Kestle; Jay Riva-Cambrin Journal: J Neurosurg Pediatr Date: 2010-09 Impact factor: 2.375
Authors: Allan R Tunkel; Rodrigo Hasbun; Adarsh Bhimraj; Karin Byers; Sheldon L Kaplan; W Michael Scheld; Diederik van de Beek; Thomas P Bleck; Hugh J L Garton; Joseph R Zunt Journal: Clin Infect Dis Date: 2017-03-15 Impact factor: 9.079
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: Thomas J Sandora; Koichi Yuki; Miho Shibamura-Fujiogi; Jennifer Ormsby; Mark Breibart; Benjamin Warf; Gregory P Priebe; Sulpicio G Soriano Journal: BMC Anesthesiol Date: 2021-04-21 Impact factor: 2.217