Role of Antibiotic-Impregnated Shunts in Preventing Shunt-Related Infections: Long-Term Outcomes in Pediatric Patients

Abstract

Background: The most common treatment for pediatric hydrocephalus is the implantation of a ventriculoperitoneal (VP) shunt. Shunt-related infections, however, continue to be one of the most frequent and dangerous side effects, resulting in higher morbidity, more surgeries, longer hospital stays, and higher medical expenses. To lessen bacterial colonization and ensuing infections, antibiotic-impregnated shunts (AIS) have been developed.

 Objective: To assess how well ventriculoperitoneal shunts impregnated with antibiotics reduce shunt-related infections and enhance long-term clinical outcomes in pediatric hydrocephalus patients.

Material and Methods: From July 2022 to August 2023, a prospective comparison study was carried out in the neurosurgery department of Mayo Hospital Lahore. 180 pediatric patients in need of their first VP shunt placement were included in the study. Patients were split into two equal groups: Group B received traditional silicone shunts (n = 90), while Group A received shunts impregnated with antibiotics (n = 90). For a whole year, patients were monitored. Shunt infection rates, time to infection, shunt revision surgery, hospital stay duration, and mortality were the main outcomes. SPSS version 26.0 was used for the statistical analysis, and p<0.05 was deemed statistically significant.

Result: The AIS group had a considerably lower infection rate (5.6%) than the traditional shunt group (16.7%) (p=0.021). Additionally, there was a significant decrease in shunt revision procedures (11.1% vs. 24.4%, p=0.026). Patients undergoing AIS had a shorter mean hospital stay (5.9±2.1 days) compared to those having traditional shunts (8.4±3.0 days, p<0.001). The AIS group had a much greater one-year shunt survival rate.

Conclusion, shunt-related infections, revision operations, hospital stays, and long-term shunt survival in pediatric hydrocephalus are all considerably reduced by antibiotic-impregnated VP shunts. In high-risk pediatric neurosurgical practice, their regular use must to be taken into account.

Keywords: Ventriculoperitoneal Shunt, Antibiotic-Impregnated Shunt, Shunt Infection, Pediatric Neurosurgery, Hydrocephalus, Long-Term Results.