Antibiotic-impregnated shunt catheters for the treatment of infantile hydrocephalus

Introduction: Antibiotic-impregnated shunt (AIS) components decrease shunt infections by preventing bacterial colonization that occurs during implantation. Despite studies showing improved efficacy in preventing infection however, concern still exists regarding using AIS components in infants, especially premature ones. In this study, clinical outcomes were assessed in infants with hydrocephalus (<1 year) following AIS placement. Methods: A prospective observational study was conducted involving pediatric patients <1 year of gestational age with hydrocephalus who underwent placement of AIS components (ventriculoperitoneal, ventriculoatrial, and cystoperitoneal) as initial treatments, shunt revision surgery, or following previous placement of a ventricular access device (VAD, Rickman reservoir). Measured outcomes included: infection, shunt revision surgery, and complications. Results: Seventy-four infants underwent 108 AIS procedures, and all were followed for over 9 months. Twenty-seven patients (36.5%) possessed previous VADs. Average weight and gestational age at birth were 1,976 g (range: 560-3,500 g) and 32.8 weeks (range: 23-41 weeks), respectively. The average age at the time of surgery was 14.6 weeks (range: 1 day to 50 weeks). Five infections occurred in 5 patients (4.6% of procedures, 6.75% of patients), 60% of which were very premature (<32 weeks). Thirty-three patients (44.6%) required shunt revision surgery, 5 (15%) for infection and 28 (85%) for malfunction. Three cerebrospinal fluid leaks occurred perioperatively without significant sequelae, and no mortalities occurred from the procedures. Conclusion: AIS systems can safely be used to treat hydrocephalus in pediatric patients <1 year old, even for those with a history of prematurity. One possible therapeutic application for such premature patients may be the incorporation of antibiotic impregnation into VADs or ventriculosubgaleal components to treat infants with hydrocephalus prior to definitive CSF shunt placement.