Effectiveness of Topical Vancomycin To Reduce The Cerebrospinal Fluid Shunt Infection

Aurangzeb Kalhoro, Abdul Sattar M. Hashim, Abdul Basit Sattar, Sanam B. Rajper

Abstract

Objective 

To assess the effectiveness of topical vancomycin in minimizing the ventriculoperitoneal shunt (VP) infection.

Study design

Cross sectional study.

Place & Duration of study

Neurospinal & Cancer Care Institute Karachi, from February 2017 to June 2020.

Methodology

The study was conducted after ethical committee approval from the hospital and all the patient gave written consent to be included in the study. The diagnosis of hydrocephalus was made on neuro-imaging like CT scan brain or MRI brain. Cerebrospinal fluid detail report was obtained to find out any infection before surgery. Additional topical vancomycin was used with infection control protocol during the surgery. The patients were followed till six months post-surgery for any infection related to the procedure.

Results 

A total of 193 patients were included in this study. There were 118 (63%) females and 75 (37%) males. The age was from 2-months to 16 years,  the mean age of 95±93 months. The mean duration of surgery was 33±7minutes. Children less than one year of age were 79 (41%). Congenital variety of hydrocephalus was the most common etiology observed in 69 (35.7%) patients. VP shunt infection occurred in 7 (3.6%) within 3-months of surgery. Coagulse-negative Staphylococci 2 (1%) and Staphylococcus aureus in 4 (2%) were the common pathogens isolated as cause of infected shunt. A p<0.05 was found for topical vancomycin and shunt infection association which was significant. However, the p- value > 0.05 was insignificant for gender and history of prematurity with VP shunt infection.

Conclusion

Use of topical vancomycin spray can significantly reduce the infection of the VP shunt.

Key words

Cerebrospinal shunt infection, Topical vancomycin, Impregnated-antibiotic catheter.