M Krause1, C V Mahr2, S Schob3, U Nestler2, R Wachowiak4. 1. Department of Neurosurgery, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany. krause@kinderneurochirurgie-leipzig.de. 2. Department of Neurosurgery, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany. 3. Division of Neuroradiology, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany. 4. Department of Pediatric Surgery, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
Abstract
INTRODUCTION: Shunt surgery in pediatric patients still bears a significant risk of infection, in addition to mechanical complications of the shunt system. Antibiotic-impregnated systems and perioperative antibiotics have been extensively studied for their potential to reduce shunt infections. We examined the effectiveness of intrawound application of vancomycin powder during shunt surgery. PATIENTS AND METHODS: Patient records of 78 primary shunt implantations at a mean age of 40 months were reviewed. In total, 52 patients (mean age 50 months) had been treated according to standard surgical and perioperative procedures (Std), whereas 26 patients (mean age 20 months) additionally had received topical application of vancomycin powder before wound closure (Vmc). Overall infection rate was 3.8%, in Std patients 5.8%, and in Vmc patients 0%. The rates of CSF fistula and revision surgery were similar in both groups (5.8% vs 8% and 23.1% vs. 30%, respectively). CONCLUSION: To the best of our knowledge, this is the first report on topical vancomycin instillation, indicating its efficacy for the prevention of shunt infection in pediatric patients. Further studies with a higher number of patients are needed to verify this finding.
INTRODUCTION: Shunt surgery in pediatric patients still bears a significant risk of infection, in addition to mechanical complications of the shunt system. Antibiotic-impregnated systems and perioperative antibiotics have been extensively studied for their potential to reduce shunt infections. We examined the effectiveness of intrawound application of vancomycin powder during shunt surgery. PATIENTS AND METHODS: Patient records of 78 primary shunt implantations at a mean age of 40 months were reviewed. In total, 52 patients (mean age 50 months) had been treated according to standard surgical and perioperative procedures (Std), whereas 26 patients (mean age 20 months) additionally had received topical application of vancomycin powder before wound closure (Vmc). Overall infection rate was 3.8%, in Std patients 5.8%, and in Vmc patients 0%. The rates of CSFfistula and revision surgery were similar in both groups (5.8% vs 8% and 23.1% vs. 30%, respectively). CONCLUSION: To the best of our knowledge, this is the first report on topical vancomycin instillation, indicating its efficacy for the prevention of shunt infection in pediatric patients. Further studies with a higher number of patients are needed to verify this finding.
Authors: Clinton J Devin; Silky Chotai; Matthew J McGirt; Alexander R Vaccaro; Jim A Youssef; Douglas G Orndorff; Paul M Arnold; Anthony K Frempong-Boadu; Isador H Lieberman; Charles Branch; Hirad S Hedayat; Ann Liu; Jeffrey C Wang; Robert E Isaacs; Kris E Radcliff; Joshua C Patt; Kristin R Archer Journal: Spine (Phila Pa 1976) Date: 2018-01-01 Impact factor: 3.468
Authors: Paul Klimo; Mark Van Poppel; Clinton J Thompson; Lissa C Baird; Ann-Christine Duhaime; Ann Marie Flannery Journal: J Neurosurg Pediatr Date: 2014-11 Impact factor: 2.375