Analysis of shunt infections in patients with neural tube defect (meningomyelocele) and hydrocephalus who underwent ventriculoperiostoneal shunting; 13 years experience of our clinic

Meningomyelocele (MM) is the most common type of neural tube defects (NTD). A significant portion of cases accompanied by hydrocephalus require shunt placement during or after sac repair. Shunt infection is one of the parameters affecting long-term prognosis and almost always presents with meningitis. In our study, we aimed to determine the risk factors, causes and disease management of patients with shunt infection/meningitis by examining newborn patients diagnosed with neural tube defect (meningomyelocele). Method: The files of newborn patients diagnosed with meningomyelocele who were born between 01.01.2010 and 11.10.2023 at Van Yüzüncü Yıl University Dursun Odabaş Medical Center and were referred to our hospital were examined retrospectively. From the hospital automation system, patients' dermographic information, hospital stay, operation day, and laboratory tests; Glucose and protein values of cerebrospinal fluid (CSF), culture and culture antibiograms were scanned. Hydrocephalus and additional accompanying anomalies were determined by examining brain computed tomography (CT), brain magnetic resonance imaging (MRI) and transfontanel ultrasonography (USG) reports. From the surgery notes; Data regarding whether a flap and shunt was applied, the diameter and location of the meningomyelocele sac, the antibiotics used, other additional anomalies in the patient, and whether the patient had meningitis and exitus were scanned from the patient's epicrisis. Results: 430 patients diagnosed with meningomyelocele were included in the study. Thirty-four patients (7.9%) were diagnosed with shunt infection/meningitis. The female sex ratio in the patients was 52.8%. Maternal age was significantly (p<0.05) lower in patients with shunt infection/meningitis than in patients without shunt infection/meningitis. Hydrocephalus rate and hospital duration were significantly higher in the patient group with shunt infection/meningitis (p<0.05). The most common pathogens in our study were Klebsiella Pneumoniae and Staphylococcus Haemolyticus. The most commonly used antibiotics in treatment were Vancomycin and Meropenem. Of the cases, 15 patients (3.5%) exited. Mortality was significantly higher in the group with shunt infection/meningitis than in the group without meningitis (p<0.05). Conclusion: In meningomyelocele, the hospital stay and death rate were significantly higher in patients with shunt infection/meningitis than in patients without shunt infection/meningitis. It was also found that the hospital stay was longer in patients who underwent flap closure and/or in patients whose operation time was longer than 72 hours. The mean maternal age was significantly lower in the shunt infection/meningitis group. The most frequently growing CSF culture pathogen was Klebsiella Pnemoniae. It is of great importance that patients are operated on as early as possible, necessary planning is made to prevent teenage pregnancies, and measures are taken to reduce hospital-acquired infections.