Revision Surgeries Are Associated With Significant Increased Risk of Subsequent Cerebrospinal Fluid Shunt Infection

The Pediatric Infectious Disease Journal, 05/31/2012

Simon TD et al. – Although younger age is associated with increased hazard of infection, subsequent cerebrospinal fluid (CSF) shunt revision significantly increases infection risk.

Methods

  • This was a retrospective cohort study of 579 children aged 0–18 years who underwent initial CSF shunt placement between January 01, 1997 and October 12, 2006 at a tertiary care children’s hospital.
  • The outcome of interest was CSF shunt infection. Data for all subsequent CSF shunt revisions leading up to and including the initial CSF shunt infection, when applicable, were obtained.
  • The likelihood of infection was determined using a Cox proportional hazard model accounting for patient characteristics and CSF shunt revisions, and is reported using hazard ratios (HR) with 95% confidence intervals (CI).

Results

  • There were 123 children who developed infection.
  • Baseline factors independently associated with hazard of infection included age 0 to <6 months at CSF shunt placement (HR 2.4, 95% CI: 1.02–6.7) and myelomeningocele (HR 0.4, 95% CI: 0.2–0.8).
  • Controlling for baseline factors, the risk of infection after shunt revision was significantly greater than at the time of initial placement (HR 3.0, 95% CI: 1.9–4.7), and this risk increased as numbers of revisions increased .

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