Cerebrospinal fluid shunt infections in children. A study on the relationship between the etiology of hydrocephalus, age at the time of shunt placement, and infection rate.

A total of 431 patients who underwent their first cerebrospinal fluid shunt insertion at Children's Memorial Hospital over a 10-year period were retrospectively studied with regard to the relationship between the etiology of the hydrocephalus, age at the time of shunt placement, and infection rate. Forty percent of the patients had constrictive hydrocephalus and meningomyelocele, 33% congenital communicating or obstructive hydrocephalus, and 18% tumors. Intraventricular hemorrhage and meningitis accounted for the remaining 8%. Eighty-three percent of the patients were less than 1 year old at the time of surgery; 18% were 1 week old or younger. A total of 1,485 procedures were performed with an average of 3 procedures per patient. Ninety-six patients had infections, resulting in a 22% infection rate per patient and a 6% infection rate per procedure. No significant correlation was evident between etiology of the hydrocephalus and infection rate (P greater than 0.05), even though meningomyelocele patients seemed to be more prone to infection than congenital hydrocephalus patients (P = 0.06). Age at the time of shunt placement was related to infection rate, with younger patients having more infections than older ones (P less than 0.01). More in-depth analysis of the relationship between age and infection rate was possible in the meningomyelocele and congenital hydrocephalus groups, owing to the significant number of these patients that fell into each one of the subdivisions chosen with respect to age at the time of shunt placement. Meningomyelocele patients shunted in the first week of life have a higher infection rate than those shunted at 2 weeks of age or older (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)