CSF SHUNT INFECTION;

PEADRIATIC CEREBROSPINAL FLUID SHUNT INFECTION. ANALYSIS OF RISK FACTORS INSTIGATING

Abstract

Hydrocephalus is the abnormal accumulation of CSF with in the ventricles and
subarachnoid spaces. It is often associated with dilatation of ventricular system and increased
ICP. Hydrocephalus is almost always a result of an interruption of CSF flow and rarely because
of increased CSF production. The definitive treatment of hydrocephalus is surgical treatment
which includes shunting and non-shunting procedures. The most common and overwhelming
complications that can occur due to the CSF shunts is infection. The risk factors associated with
pediatric CSF shunt infection has been analyzed in this study. Study Design: Descriptive study.
Setting: Department of Neurosurgery, Nishtar Hospital Multan & Sheikh Zayed Hospital Rahim
Yar Khan. Period: Three years 01-07-2013 to 01-07-2016. Method: Total 209 eligible patients
who were operated for CSF shunt were keenly monitored. Several variables were observed
and the responses against these variables were noted down. Post operative follow up of all
these cases done for 6 months in order to notice any development of infection (clinical signs
of infection & CSF examination) in CSF shunt system. Chi-square method was used applied
in order to analyze the association among the variables and shunt infection development.In
our population of 209 patients only twenty six patients (12.44%) suffered from shunt infection.
In this study four variables were qualified as having significant association with greater risk of
shunt infection. 1) Patient age. 2) Inadvertently exposure of surgical instruments to the shunt
system. 3) the existence of large number of previous shunt systems. 4) manual handling of
shunt system Conclusions: Four variables have been reported by this study which can be a
great source of shunt infection.it is recommended that changes in clinical practice should be
considered in order to avoid these. Few recommendations are as follows. 1) While handling the
shunt system great care should be taken. 2) It should be taken care that the manual contact
of the Surgeons with the shunt system should be minimum. 3) it is recommended that the
alternatives other then the shunt insertion should be considered especially for the children. 4)
Great number of previous shunt system is also a great risk factor and these patients must be
handled as individuals at high risk.