Variability in Management of First Cerebrospinal Fluid Shunt Infection: A Prospective Multi-Institutional Observational Cohort Study
Objectives To describe the variation in approaches to surgical and antibiotic treatment for first cerebrospinal fluid (CSF) shunt infection and adherence to Infectious Diseases Society of America (IDSA) guidelines. Study design We conducted a prospective cohort study of children undergoing treatment...
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| Veröffentlicht in: | The Journal of pediatrics 2016-12, Vol.179, p.185-191.e2 |
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| creator | Simon, Tamara D., MD, MSPH Kronman, Matthew P., MD, MSCE Whitlock, Kathryn B., MS Gove, Nancy, PhD Browd, Samuel R., MD, PhD Holubkov, Richard, PhD Kestle, John R.W., MD Kulkarni, Abhaya V., MD, PhD Langley, Marcie, BS Limbrick, David D., MD, PhD Luerssen, Thomas G., MD Oakes, Jerry, MD Riva-Cambrin, Jay, MD, MSc Rozzelle, Curtis, MD Shannon, Chevis, DrPH Tamber, Mandeep, MD, PhD Wellons, John C., MD, MSPH Whitehead, William E., MD, MPH Mayer-Hamblett, Nicole, PhD |
| description | Objectives To describe the variation in approaches to surgical and antibiotic treatment for first cerebrospinal fluid (CSF) shunt infection and adherence to Infectious Diseases Society of America (IDSA) guidelines. Study design We conducted a prospective cohort study of children undergoing treatment for first CSF infection at 7 Hydrocephalus Clinical Research Network hospitals from April 2008 through December 2012. Univariate analyses were performed to describe the study population. Results A total of 151 children underwent treatment for first CSF shunt-related infection. Most children had undergone initial CSF shunt placement before the age of 6 months (n = 98, 65%). Median time to infection after shunt surgery was 28 days (IQR 15-52 days). Surgical management was most often shunt removal with interim external ventricular drain placement, followed by new shunt insertion (n = 122, 81%). Median time from first negative CSF culture to final surgical procedure was 14 days (IQR 10-21 days). Median duration of intravenous (IV) antibiotic use duration was 19 days (IQR 12-28 days). For 84 infections addressed by IDSA guidelines, 7 (8%) met guidelines and 61 (73%) had longer duration of IV antibiotic use than recommended. Conclusions Surgical treatment for infection frequently adheres to IDSA guidelines of shunt removal with external ventricular drain placement followed by new shunt insertion. However, duration of IV antibiotic use in CSF shunt infection treatment was consistently longer than recommended by the 2004 IDSA guidelines. |
| doi_str_mv | 10.1016/j.jpeds.2016.08.094 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5123958</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S0022347616308770</els_id><sourcerecordid>1835390520</sourcerecordid><originalsourceid>FETCH-LOGICAL-c514t-31a452f5fe4bd70dfd491610d2441cfd3955ab57fca7fd34390fc8f0a856aec53</originalsourceid><addsrcrecordid>eNqFkl-LEzEUxQdR3Lr6CQTJoy8zJpPJ_BFcWIrVwi4rVH0NmeRmm3Ga1CRT6Lsf3Iyti_riUzjkd-7NvSdZ9pLggmBSvxmKYQ8qFGUSBW4L3FWPsgXBXZPXLaWPswXGZZnTqqkvsmchDBgnBOOn2UXZ1F1Z1XSR_fgqvBG9GU08ImPRrbDiHnZgI3IarYwPES3BQ-9d2BsrRrQaJ6PQZjslZG01yGicfYuu0acZmeUB0O00RpOvbYgmTjOQjHd9AH8QZ7V0W-cj2sRJHZ9nT7QYA7w4n5fZl9X7z8uP-c3dh_Xy-iaXjFQxp0RUrNRMQ9WrBiutqo7UBKuyqojUinaMiZ41WoomqYp2WMtWY9GyWoBk9DK7OtXdT_0OlExTejHyvTc74Y_cCcP_vrFmy-_dgTNSpuJtKvD6XMC77xOEyHcmSBhHYcFNgZOWstSVlTih9ITKtJbgQT-0IZjP-fGB_8qPz_lx3PIUTnK9-vOFD57fgSXg3QmAtKeDAc-DNGAlKOPT7rly5j8Nrv7xy9FYI8X4DY4QBjf5lE6ahIeSY76Zv9D8g0hNcds0mP4ER5PGUQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1835390520</pqid></control><display><type>article</type><title>Variability in Management of First Cerebrospinal Fluid Shunt Infection: A Prospective Multi-Institutional Observational Cohort Study</title><source>MEDLINE</source><source>Access via ScienceDirect (Elsevier)</source><creator>Simon, Tamara D., MD, MSPH ; Kronman, Matthew P., MD, MSCE ; Whitlock, Kathryn B., MS ; Gove, Nancy, PhD ; Browd, Samuel R., MD, PhD ; Holubkov, Richard, PhD ; Kestle, John R.W., MD ; Kulkarni, Abhaya V., MD, PhD ; Langley, Marcie, BS ; Limbrick, David D., MD, PhD ; Luerssen, Thomas G., MD ; Oakes, Jerry, MD ; Riva-Cambrin, Jay, MD, MSc ; Rozzelle, Curtis, MD ; Shannon, Chevis, DrPH ; Tamber, Mandeep, MD, PhD ; Wellons, John C., MD, MSPH ; Whitehead, William E., MD, MPH ; Mayer-Hamblett, Nicole, PhD</creator><creatorcontrib>Simon, Tamara D., MD, MSPH ; Kronman, Matthew P., MD, MSCE ; Whitlock, Kathryn B., MS ; Gove, Nancy, PhD ; Browd, Samuel R., MD, PhD ; Holubkov, Richard, PhD ; Kestle, John R.W., MD ; Kulkarni, Abhaya V., MD, PhD ; Langley, Marcie, BS ; Limbrick, David D., MD, PhD ; Luerssen, Thomas G., MD ; Oakes, Jerry, MD ; Riva-Cambrin, Jay, MD, MSc ; Rozzelle, Curtis, MD ; Shannon, Chevis, DrPH ; Tamber, Mandeep, MD, PhD ; Wellons, John C., MD, MSPH ; Whitehead, William E., MD, MPH ; Mayer-Hamblett, Nicole, PhD ; Hydrocephalus Clinical Research Network (HCRN)</creatorcontrib><description>Objectives To describe the variation in approaches to surgical and antibiotic treatment for first cerebrospinal fluid (CSF) shunt infection and adherence to Infectious Diseases Society of America (IDSA) guidelines. Study design We conducted a prospective cohort study of children undergoing treatment for first CSF infection at 7 Hydrocephalus Clinical Research Network hospitals from April 2008 through December 2012. Univariate analyses were performed to describe the study population. Results A total of 151 children underwent treatment for first CSF shunt-related infection. Most children had undergone initial CSF shunt placement before the age of 6 months (n = 98, 65%). Median time to infection after shunt surgery was 28 days (IQR 15-52 days). Surgical management was most often shunt removal with interim external ventricular drain placement, followed by new shunt insertion (n = 122, 81%). Median time from first negative CSF culture to final surgical procedure was 14 days (IQR 10-21 days). Median duration of intravenous (IV) antibiotic use duration was 19 days (IQR 12-28 days). For 84 infections addressed by IDSA guidelines, 7 (8%) met guidelines and 61 (73%) had longer duration of IV antibiotic use than recommended. Conclusions Surgical treatment for infection frequently adheres to IDSA guidelines of shunt removal with external ventricular drain placement followed by new shunt insertion. However, duration of IV antibiotic use in CSF shunt infection treatment was consistently longer than recommended by the 2004 IDSA guidelines.</description><identifier>ISSN: 0022-3476</identifier><identifier>EISSN: 1097-6833</identifier><identifier>DOI: 10.1016/j.jpeds.2016.08.094</identifier><identifier>PMID: 27692463</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>antibiotic ; Bacterial Infections - etiology ; Bacterial Infections - therapy ; cerebrospinal ; Cerebrospinal Fluid Shunts - adverse effects ; Child, Preschool ; Cohort Studies ; Female ; Guideline Adherence - statistics & numerical data ; Humans ; Infant ; Infant, Newborn ; infection ; Male ; Pediatrics ; Postoperative Complications - etiology ; Postoperative Complications - therapy ; Prospective Studies ; shunt ; treatment</subject><ispartof>The Journal of pediatrics, 2016-12, Vol.179, p.185-191.e2</ispartof><rights>Elsevier Inc.</rights><rights>2016 Elsevier Inc.</rights><rights>Copyright © 2016 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c514t-31a452f5fe4bd70dfd491610d2441cfd3955ab57fca7fd34390fc8f0a856aec53</citedby><cites>FETCH-LOGICAL-c514t-31a452f5fe4bd70dfd491610d2441cfd3955ab57fca7fd34390fc8f0a856aec53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jpeds.2016.08.094$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,315,781,785,886,3551,27929,27930,46000</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27692463$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Simon, Tamara D., MD, MSPH</creatorcontrib><creatorcontrib>Kronman, Matthew P., MD, MSCE</creatorcontrib><creatorcontrib>Whitlock, Kathryn B., MS</creatorcontrib><creatorcontrib>Gove, Nancy, PhD</creatorcontrib><creatorcontrib>Browd, Samuel R., MD, PhD</creatorcontrib><creatorcontrib>Holubkov, Richard, PhD</creatorcontrib><creatorcontrib>Kestle, John R.W., MD</creatorcontrib><creatorcontrib>Kulkarni, Abhaya V., MD, PhD</creatorcontrib><creatorcontrib>Langley, Marcie, BS</creatorcontrib><creatorcontrib>Limbrick, David D., MD, PhD</creatorcontrib><creatorcontrib>Luerssen, Thomas G., MD</creatorcontrib><creatorcontrib>Oakes, Jerry, MD</creatorcontrib><creatorcontrib>Riva-Cambrin, Jay, MD, MSc</creatorcontrib><creatorcontrib>Rozzelle, Curtis, MD</creatorcontrib><creatorcontrib>Shannon, Chevis, DrPH</creatorcontrib><creatorcontrib>Tamber, Mandeep, MD, PhD</creatorcontrib><creatorcontrib>Wellons, John C., MD, MSPH</creatorcontrib><creatorcontrib>Whitehead, William E., MD, MPH</creatorcontrib><creatorcontrib>Mayer-Hamblett, Nicole, PhD</creatorcontrib><creatorcontrib>Hydrocephalus Clinical Research Network (HCRN)</creatorcontrib><title>Variability in Management of First Cerebrospinal Fluid Shunt Infection: A Prospective Multi-Institutional Observational Cohort Study</title><title>The Journal of pediatrics</title><addtitle>J Pediatr</addtitle><description>Objectives To describe the variation in approaches to surgical and antibiotic treatment for first cerebrospinal fluid (CSF) shunt infection and adherence to Infectious Diseases Society of America (IDSA) guidelines. Study design We conducted a prospective cohort study of children undergoing treatment for first CSF infection at 7 Hydrocephalus Clinical Research Network hospitals from April 2008 through December 2012. Univariate analyses were performed to describe the study population. Results A total of 151 children underwent treatment for first CSF shunt-related infection. Most children had undergone initial CSF shunt placement before the age of 6 months (n = 98, 65%). Median time to infection after shunt surgery was 28 days (IQR 15-52 days). Surgical management was most often shunt removal with interim external ventricular drain placement, followed by new shunt insertion (n = 122, 81%). Median time from first negative CSF culture to final surgical procedure was 14 days (IQR 10-21 days). Median duration of intravenous (IV) antibiotic use duration was 19 days (IQR 12-28 days). For 84 infections addressed by IDSA guidelines, 7 (8%) met guidelines and 61 (73%) had longer duration of IV antibiotic use than recommended. Conclusions Surgical treatment for infection frequently adheres to IDSA guidelines of shunt removal with external ventricular drain placement followed by new shunt insertion. However, duration of IV antibiotic use in CSF shunt infection treatment was consistently longer than recommended by the 2004 IDSA guidelines.</description><subject>antibiotic</subject><subject>Bacterial Infections - etiology</subject><subject>Bacterial Infections - therapy</subject><subject>cerebrospinal</subject><subject>Cerebrospinal Fluid Shunts - adverse effects</subject><subject>Child, Preschool</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Guideline Adherence - statistics & numerical data</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>infection</subject><subject>Male</subject><subject>Pediatrics</subject><subject>Postoperative Complications - etiology</subject><subject>Postoperative Complications - therapy</subject><subject>Prospective Studies</subject><subject>shunt</subject><subject>treatment</subject><issn>0022-3476</issn><issn>1097-6833</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkl-LEzEUxQdR3Lr6CQTJoy8zJpPJ_BFcWIrVwi4rVH0NmeRmm3Ga1CRT6Lsf3Iyti_riUzjkd-7NvSdZ9pLggmBSvxmKYQ8qFGUSBW4L3FWPsgXBXZPXLaWPswXGZZnTqqkvsmchDBgnBOOn2UXZ1F1Z1XSR_fgqvBG9GU08ImPRrbDiHnZgI3IarYwPES3BQ-9d2BsrRrQaJ6PQZjslZG01yGicfYuu0acZmeUB0O00RpOvbYgmTjOQjHd9AH8QZ7V0W-cj2sRJHZ9nT7QYA7w4n5fZl9X7z8uP-c3dh_Xy-iaXjFQxp0RUrNRMQ9WrBiutqo7UBKuyqojUinaMiZ41WoomqYp2WMtWY9GyWoBk9DK7OtXdT_0OlExTejHyvTc74Y_cCcP_vrFmy-_dgTNSpuJtKvD6XMC77xOEyHcmSBhHYcFNgZOWstSVlTih9ITKtJbgQT-0IZjP-fGB_8qPz_lx3PIUTnK9-vOFD57fgSXg3QmAtKeDAc-DNGAlKOPT7rly5j8Nrv7xy9FYI8X4DY4QBjf5lE6ahIeSY76Zv9D8g0hNcds0mP4ER5PGUQ</recordid><startdate>20161201</startdate><enddate>20161201</enddate><creator>Simon, Tamara D., MD, MSPH</creator><creator>Kronman, Matthew P., MD, MSCE</creator><creator>Whitlock, Kathryn B., MS</creator><creator>Gove, Nancy, PhD</creator><creator>Browd, Samuel R., MD, PhD</creator><creator>Holubkov, Richard, PhD</creator><creator>Kestle, John R.W., MD</creator><creator>Kulkarni, Abhaya V., MD, PhD</creator><creator>Langley, Marcie, BS</creator><creator>Limbrick, David D., MD, PhD</creator><creator>Luerssen, Thomas G., MD</creator><creator>Oakes, Jerry, MD</creator><creator>Riva-Cambrin, Jay, MD, MSc</creator><creator>Rozzelle, Curtis, MD</creator><creator>Shannon, Chevis, DrPH</creator><creator>Tamber, Mandeep, MD, PhD</creator><creator>Wellons, John C., MD, MSPH</creator><creator>Whitehead, William E., MD, MPH</creator><creator>Mayer-Hamblett, Nicole, PhD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20161201</creationdate><title>Variability in Management of First Cerebrospinal Fluid Shunt Infection: A Prospective Multi-Institutional Observational Cohort Study</title><author>Simon, Tamara D., MD, MSPH ; Kronman, Matthew P., MD, MSCE ; Whitlock, Kathryn B., MS ; Gove, Nancy, PhD ; Browd, Samuel R., MD, PhD ; Holubkov, Richard, PhD ; Kestle, John R.W., MD ; Kulkarni, Abhaya V., MD, PhD ; Langley, Marcie, BS ; Limbrick, David D., MD, PhD ; Luerssen, Thomas G., MD ; Oakes, Jerry, MD ; Riva-Cambrin, Jay, MD, MSc ; Rozzelle, Curtis, MD ; Shannon, Chevis, DrPH ; Tamber, Mandeep, MD, PhD ; Wellons, John C., MD, MSPH ; Whitehead, William E., MD, MPH ; Mayer-Hamblett, Nicole, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c514t-31a452f5fe4bd70dfd491610d2441cfd3955ab57fca7fd34390fc8f0a856aec53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>antibiotic</topic><topic>Bacterial Infections - etiology</topic><topic>Bacterial Infections - therapy</topic><topic>cerebrospinal</topic><topic>Cerebrospinal Fluid Shunts - adverse effects</topic><topic>Child, Preschool</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Guideline Adherence - statistics & numerical data</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>infection</topic><topic>Male</topic><topic>Pediatrics</topic><topic>Postoperative Complications - etiology</topic><topic>Postoperative Complications - therapy</topic><topic>Prospective Studies</topic><topic>shunt</topic><topic>treatment</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Simon, Tamara D., MD, MSPH</creatorcontrib><creatorcontrib>Kronman, Matthew P., MD, MSCE</creatorcontrib><creatorcontrib>Whitlock, Kathryn B., MS</creatorcontrib><creatorcontrib>Gove, Nancy, PhD</creatorcontrib><creatorcontrib>Browd, Samuel R., MD, PhD</creatorcontrib><creatorcontrib>Holubkov, Richard, PhD</creatorcontrib><creatorcontrib>Kestle, John R.W., MD</creatorcontrib><creatorcontrib>Kulkarni, Abhaya V., MD, PhD</creatorcontrib><creatorcontrib>Langley, Marcie, BS</creatorcontrib><creatorcontrib>Limbrick, David D., MD, PhD</creatorcontrib><creatorcontrib>Luerssen, Thomas G., MD</creatorcontrib><creatorcontrib>Oakes, Jerry, MD</creatorcontrib><creatorcontrib>Riva-Cambrin, Jay, MD, MSc</creatorcontrib><creatorcontrib>Rozzelle, Curtis, MD</creatorcontrib><creatorcontrib>Shannon, Chevis, DrPH</creatorcontrib><creatorcontrib>Tamber, Mandeep, MD, PhD</creatorcontrib><creatorcontrib>Wellons, John C., MD, MSPH</creatorcontrib><creatorcontrib>Whitehead, William E., MD, MPH</creatorcontrib><creatorcontrib>Mayer-Hamblett, Nicole, PhD</creatorcontrib><creatorcontrib>Hydrocephalus Clinical Research Network (HCRN)</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The Journal of pediatrics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Simon, Tamara D., MD, MSPH</au><au>Kronman, Matthew P., MD, MSCE</au><au>Whitlock, Kathryn B., MS</au><au>Gove, Nancy, PhD</au><au>Browd, Samuel R., MD, PhD</au><au>Holubkov, Richard, PhD</au><au>Kestle, John R.W., MD</au><au>Kulkarni, Abhaya V., MD, PhD</au><au>Langley, Marcie, BS</au><au>Limbrick, David D., MD, PhD</au><au>Luerssen, Thomas G., MD</au><au>Oakes, Jerry, MD</au><au>Riva-Cambrin, Jay, MD, MSc</au><au>Rozzelle, Curtis, MD</au><au>Shannon, Chevis, DrPH</au><au>Tamber, Mandeep, MD, PhD</au><au>Wellons, John C., MD, MSPH</au><au>Whitehead, William E., MD, MPH</au><au>Mayer-Hamblett, Nicole, PhD</au><aucorp>Hydrocephalus Clinical Research Network (HCRN)</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Variability in Management of First Cerebrospinal Fluid Shunt Infection: A Prospective Multi-Institutional Observational Cohort Study</atitle><jtitle>The Journal of pediatrics</jtitle><addtitle>J Pediatr</addtitle><date>2016-12-01</date><risdate>2016</risdate><volume>179</volume><spage>185</spage><epage>191.e2</epage><pages>185-191.e2</pages><issn>0022-3476</issn><eissn>1097-6833</eissn><abstract>Objectives To describe the variation in approaches to surgical and antibiotic treatment for first cerebrospinal fluid (CSF) shunt infection and adherence to Infectious Diseases Society of America (IDSA) guidelines. Study design We conducted a prospective cohort study of children undergoing treatment for first CSF infection at 7 Hydrocephalus Clinical Research Network hospitals from April 2008 through December 2012. Univariate analyses were performed to describe the study population. Results A total of 151 children underwent treatment for first CSF shunt-related infection. Most children had undergone initial CSF shunt placement before the age of 6 months (n = 98, 65%). Median time to infection after shunt surgery was 28 days (IQR 15-52 days). Surgical management was most often shunt removal with interim external ventricular drain placement, followed by new shunt insertion (n = 122, 81%). Median time from first negative CSF culture to final surgical procedure was 14 days (IQR 10-21 days). Median duration of intravenous (IV) antibiotic use duration was 19 days (IQR 12-28 days). For 84 infections addressed by IDSA guidelines, 7 (8%) met guidelines and 61 (73%) had longer duration of IV antibiotic use than recommended. Conclusions Surgical treatment for infection frequently adheres to IDSA guidelines of shunt removal with external ventricular drain placement followed by new shunt insertion. However, duration of IV antibiotic use in CSF shunt infection treatment was consistently longer than recommended by the 2004 IDSA guidelines.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27692463</pmid><doi>10.1016/j.jpeds.2016.08.094</doi><oa>free_for_read</oa></addata></record> |
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| subjects | antibiotic Bacterial Infections - etiology Bacterial Infections - therapy cerebrospinal Cerebrospinal Fluid Shunts - adverse effects Child, Preschool Cohort Studies Female Guideline Adherence - statistics & numerical data Humans Infant Infant, Newborn infection Male Pediatrics Postoperative Complications - etiology Postoperative Complications - therapy Prospective Studies shunt treatment |
| title | Variability in Management of First Cerebrospinal Fluid Shunt Infection: A Prospective Multi-Institutional Observational Cohort Study |
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