Retrospective evaluation of ventriculoperitoneal shunt infections and risk factors in children 2016-2021

Introduction: The most effective treatment options in the treatment of hydrocephalus are surgical methods. Ventriculoperitoneal shunt application, which provides drainage of the cerebrospinal fluid, has been widely used for many years in the treatment of hydrocephalus. Although recent developments in surgical techniques and shunt designs applied today have significantly reduced the rate of shunt complications, ventriculoperitoneal shunt infections continue to be the most common complications of ventriculoperitoneal shunt applications. Aim: In this study, we aimed to evaluate the demographic, clinical, diagnostic, and treatment characteristics of pediatric patients who underwent ventriculoperitoneal shunt due to hydrocephalus and developed ventriculoperitoneal shunt infection, and to evaluate the risk factors for the development of ventriculoperitoneal shunt infections and ventriculoperitoneal shunt infection recurrence. Materials and Methods: Patients aged 0-18 years, who were diagnosed with ventriculoperitoneal shunt infection and hospitalized for follow-up and treatment in the Pediatric Infection and Neurosurgery Service of Çukurova University Medical Faculty Balcalı Hospital between January 2016 - December 2021 were included in the study. Demographic, clinical, laboratory, treatment characteristics of the patients and risk factors for the development of ventriculoperitoneal shunt infection were evaluated retrospectively. Patients who developed and did not develop ventriculoperitoneal shunt infection after treatment were compared in order to evaluate the risk factors for infection reccurence in ventriculoperitoneal shunt infections. In our study, 48 patients aged 0-18 years, who underwent ventriculoperitoneal shunt in the neurosurgery clinic and did not develop ventriculoperitoneal shunt infection, were included in the study as the control group in order to evaluate the risk factors for the development of ventriculoperitoneal shunt infections. Findings: 85 patients diagnosed with ventriculoperitoneal shunt infection were included in our study. 56.5% (n=48) of the patients were male. The mean age of the patients was 33.6±41.9 months (min-max: 2-178 months). Fever (58.8%), loss of appetite (58.8%), vomiting (56.5%) and altered consciousness (54.1%) were the most common complaints at first admission. The CSF cultures of 85 patients, who were followed up for ventriculoperitoneal shunt infection, taken before treatment had growth in 40% and gram positive growth in 64.7%. The number of shunt revisions was statistically significantly higher in the group that developed ventriculoperitoneal shunt infection, compared to the control group (p<0.001). When the control group and patients with ventriculoperitoneal shunt infection were compared, the CRP and CSF protein values before shunt insertion at the time of 13 first admission to the hospital were found to be statistically higher in the group with VPS infection compared to the group without VPS infection (p<0.001). The CSF protein cutoff value for the development of ventriculoperitoneal shunt infection was determined as 107.5 (95% CI AUC 0.69-0.94). It was determined that CSF protein level above 107.5 before shunt insertion increased the risk of developing ventriculoperitoneal shunt infection in the patient with 80% probability, 62.5% sensitivity and 66.7% specificity. The cut-off value for CRP was 1.95 (95% CI AUC 0.60-0.97). If the patient's CRP value was >1.95, it was determined that the risk of developing ventriculoperitoneal shunt infection was increased with 79% probability, 72.9% sensitivity, and 88.9% specificity. Conclusion: Ventriculoperitoneal shunt infection develops most frequently in the first few months after shunting. Therefore, it is extremely important to prevent colonization and contamination during surgery in preventing the development of ventriculoperitoneal shunt infection. In our study, CSF protein elevation before shunt insertion, and CRP elevation were found to be significant in terms of the development and recurrence of ventriculoperitoneal shunt infection, and we think that keeping protein levels at 100 and below, especially before ventriculoperitoneal shunt infection, may prevent the development of ventriculoperitoneal shunt infection. Keywords: Hydrocephalus, child, ventriculoperitoneal shunt, ventriculoperitoneal shunt infection