LONG-TERM ANALYSIS OF CEREBROSPINAL-FLUID SHUNT INFECTIONS - 25-YEAR EXPERIENCE

Retrospective analysis of 840 CSF shunting procedures over a 25 yr period to determine the relationships between infection rates and several possible influences on infection. Of all shunt infections, 2/3 occurred within 1 mo. of surgery. The very young and very old had higher infection rates. Infections became less prevalent over the period of the study, and mortality from infection decreased from 35-6%. Successive shunts (revisions) had progressively higher infection rates. Ventriculoatrial and ventriculoperitoneal silicone plastic shunts had similar infection rates (11.4%) and 12.0%). The uncontrolled use of prophylactic antibiotics had no effect on shunt infections. Staphylococcus epidermidis became gradually more prevalent over the period of the study, and eventually caused 1/2 of all infections. Where infection occurred in the presence of prophylaxis, the infectious organism was usually sensitive to the antibiotic being used. The surgeon was the largest single factor in the incidence of shunt infections. A 25-fold variance in infection rates among surgeons could be related to individual experience and technique.