[Frequency of infections after shunting of hydrocephalus. An analysis of 884 shunts].

Postoperative infections are major complications to cerebrospinal fluid (CSF) shunting in the treatment of hydrocephalus and other conditions with impeded CSF transportation. In a retrospective study 884 first-time shunts inserted in the years 1958-1989 are investigated. Infection rate is studied including influence of following variables: time period, age of patient, education of neurosurgeon, length and time of operation and placement of the distal drain. Overall infection rate for all implanted CSF shunts is 7.4% (5.7-9.3%) and acute rate of infection is 6.2% (4.6-7.9%). Rate of infection is virtually constant for all variables except education of the neurosurgeon. Neurosurgical trainees have significantly higher infection rates. Use of prophylactic antibiotics is still controversial No prospective, double blinded studies including sufficient number of patients to evaluate this issue exist today. Meta-analysis studies conclude that use of prophylactic antibiotics is associated with a significant reduction in subsequent CSF shunt infection. We recommend that shunt implantation primarily be performed by highly trained neurosurgeons and that there should be increased supervision during CSF shunt operations performed by neurosurgical trainees.