A Fifteen-year Epidemiological Study of Ventriculoperitoneal Shunt Infections in Pediatric Patients: A Single Center Experience

Yeon Kyung Kim; Hyung Jin Shin; Yae Jean Kim

doi:10.14776/kjpid.2012.19.3.141

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Kim, Shin, and Kim: A Fifteen-year Epidemiological Study of Ventriculoperitoneal Shunt Infections in Pediatric Patients: A Single Center Experience

Original Article

Korean Journal of Pediatric Infectious Diseases

Korean Journal of Pediatric Infectious Diseases 2012; 19(3): 141-148.

Published online: 31 December 2012

DOI: https://doi.org/10.14776/kjpid.2012.19.3.141

A Fifteen-year Epidemiological Study of Ventriculoperitoneal Shunt Infections in Pediatric Patients: A Single Center Experience

Yeon Kyung Kim, M.D., Hyung Jin Shin, M.D.^*, Yae Jean Kim, M.D.

Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

^*Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Correspondence: Yae Jean Kim, M.D. Department of Pediatrics, Sungkyunkwan University School of Medicine, Samsung Medical Center. Tel: +82-2-3410-3539, Fax: +82-2-3410-0043, yaejeankim@skku.edu

Received 12 October 2012 Revised 22 October 2012 Accepted 24 October 2012

Abstract

Purpose

Ventriculoperitoneal (VP) shunt insertion is an important treatment modality in children with hydrocephalus. VP shunt infection is a major complication and an important factor that determines the surgery outcome. This 15-year study was performed to evaluate the epidemiology of VP shunt infections in pediatric patients treated at our center.

Methods

A retrospective review of medical records was performed in patients 18 years old or younger who underwent VP shunt insertion surgery from April 1995 to June 2010.

Results

Three hundred twenty-seven VP shunt surgeries were performed in a total of 190 pediatric patients (83 females, 107 males). The median age of the patients was 2.4 years (range, 0.02-17.9 years). Having a malignant brain tumor was the most frequent cause for VP shunt insertion. The shunt infection rate was 6.7% (22/327) per 100 operations and 9.5% (18/190) per 100 patients, and the incidence rate was 0.45 infection cases per 100 shunt operations-year. The most common pathogen was coagulase-negative staphylococcus (n=7) followed by methicillin resistant Staphylococcus aureus (n=1). Ten cases were treated with vancomycin and beta-lactam antibiotic (cephalosporin or carbapenem) combination therapy and 7 cases were treated with vancomycin monotherapy. The median duration of antibiotic treatment was 26 days (range, 7 to 58 days). Surgical intervention was performed in 18 cases (18/22, 81.8%).

Conclusion

Epidemiologic information regarding VP shunt infections in pediatric patients is valuable that will help guide proper antibiotic management. Additional studies on the risk factors for developing VP shunt infections are also warranted.

Keywords: Ventriculoperitoneal shunt, Infectious complications, Children

Figures and Tables

Table 1

Characteristics of Children Who Underwent Ventriculoperitoenal Shunt Operations

^*Posthemorrhagic hydrocephalus due to arteriovenous malformation and hydrocephalus due to mucopolysaccharides

Table 2

Ventriculoperitoneal Shunt Infection Details

^*Fever is defined as having a temperature of over 38℃. Other symptoms overlapped with fever.

^†Ceftriaxone, ceftazidime and tobramycin, piperacillin/tazobactam and amikacin

Table 3

Characteristics of Patients with Shunt Infections

Abbreviations : Pt, patient; meng, meningitis; cHCP, congenital hydrocephalus; recur, recurrent infection; cmHCP, communicating hydrocephalus; tSDH, traumatic subdural hemorrhage; HCP, hydrocephalus; MPS, mucopolysaccharide; hHCP, posthemorrhagic hydrocephalus; IVH, intraventricular hemorrhage in preterm infant; abd pain, abdominal pain; vanco, vancomycin; teico, teicoplanin; pi/tazo, piperacillin/tazobactam; EVD, external ventricular drain.

^*The number of days after surgery that the symptoms began occurring.

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