RISK OF INFECTION AFTER CEREBROSPINAL-FLUID SHUNT - AN ANALYSIS OF 884 FIRST-TIME SHUNTS

Postoperative infections are major complications of cerebrospinal flui d (CSF) shunting in the treatment of hydrocephalus and other condition s with obstructed CSF circulation. In a retrospective study 884 first- time shunted patients with hydrocephalus operated on in the years 1958 -1989 were investigated with special reference to the infection rate a nd to the influence of the following variables: time period, age of th e patient, education of the neurosurgeon, length and time of the opera tion and the exact placement of the distal drain. The overall infectio n rate for all implanted CSF shunts was 7.4% (5.7-9.3%) and the acute rate of infection was 6.2% (4.6-7.9%). The rate of infection was virtu ally constant for all variables with the exception of the education of the neurosurgeon. Neurosurgical trainees particularly had a significa ntly higher rate of infection. Shunt infection is still a major compli cation. The infection rate has not declined in recent decades. It is n ot possible to relate any main cause to the infection rate. The litera ture recommends removal of the infected shunt combined with antibiotic s. The use of prophylactic antibiotics is still controversial. No pros pective, double-blind studies, including a sufficiently large number o f patients to evaluate this issue, exist today.