{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T13:14:50Z","timestamp":1772111690841,"version":"3.50.1"},"reference-count":34,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,10,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>The Hydrocephalus Clinical Research Network (HCRN) implemented a perioperative infection prevention bundle for all CSF shunt surgeries in 2007 that included the relatively unproven technique of intrathecal instillation of the broad-spectrum antibiotics vancomycin and gentamicin into the shunt. In the meantime, the field debated the use of antibiotic-impregnated catheter (AIC) shunt tubing using clindamycin and rifampin, an increasingly widespread, but expensive and controversial, technique. It is unknown whether there were changes in infecting organisms associated with the use of these techniques during CSF shunt surgery at the hospital level. Key comparison periods include during the use of intrathecal antibiotics (period 1 from June 1, 2007, to December 31, 2011, at HCRN hospitals) and AIC (period 2 from January 1, 2012, to December 31, 2015, at HCRN as well as increasing over time at non-HCRN hospitals) and only standard use of routine prophylactic antibiotics (period 1 at non-HCRN hospitals). The aim of this study was to examine rates of CSF shunt surgery\u2013related infections from 2007 to 2012 at the hospital level, including HCRN and non-HCRN hospitals, with a focus on infections with gram-negative organisms.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>The authors conducted a retrospective observational cohort study at 6 children\u2019s hospitals with enrollment from 2007 to 2012 and surveillance through 2015. Bimonthly rates of shunt surgery\u2013related infections were summarized to produce an overall hospital-specific time series, as well as by HCRN\/non-HCRN status. An interrupted time series analysis was performed to assess the impact of change in HCRN perioperative infection prevention bundle on overall bimonthly infection rates. Quarterly rates of gram-negative shunt surgery\u2013related infections were summarized to produce an overall hospital-specific time series.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>The overall bimonthly CSF shunt infection rate over time did not change significantly from 2007 to 2012. There was no difference in the trajectory of infection rates between HCRN and non-HCRN hospitals during the entire study period. No change in distributions of gram-negative organism infections was observed in hospitals from 2007 to 2015.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>There were no differences observed in hospital-level infection rates for low-risk patients undergoing CSF shunt surgery. This included analyses based on participation in the HCRN network, given their regular use of intrathecal antibiotics in period 1 and a focus on gram-negative infections with increasing adoption of AICs in period 2.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2024.5.peds23372","type":"journal-article","created":{"date-parts":[[2024,7,24]],"date-time":"2024-07-24T04:10:45Z","timestamp":1721794245000},"page":"357-364","source":"Crossref","is-referenced-by-count":2,"title":["Infection rates during eras of intrathecal antibiotic use followed by antibiotic-impregnated catheter use in prevention of cerebrospinal fluid shunt infection"],"prefix":"10.3171","volume":"34","author":[{"given":"Tamara D.","family":"Simon","sequence":"first","affiliation":[{"name":"The Saban Research Institute, Children\u2019s Hospital Los Angeles, California;"},{"name":"Division of Hospital Medicine, Department of Pediatrics, University of Southern California, Keck School of Medicine, Los Angeles, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Panteha","family":"Hayati Rezvan","sequence":"additional","affiliation":[{"name":"The Saban Research Institute, Children\u2019s Hospital Los Angeles, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan E.","family":"Coffin","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Hall","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital Association, Lenexa, Kansas;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason S.","family":"Hauptman","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew P.","family":"Kronman","sequence":"additional","affiliation":[{"name":"Pediatrics, University of Washington, School of Medicine, Seattle, Washington;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco T.","family":"Mangano","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stacey","family":"Podkovik","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Riverside University Health Sciences Medical Center, Riverside, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian F.","family":"Pollack","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua K.","family":"Schaffzin","sequence":"additional","affiliation":[{"name":"Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio;"},{"name":"Faculty of Medicine, University of Ottawa, Ontario, Canada;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily","family":"Thorell","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin C.","family":"Warf","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Harvard School of Medicine, Boston, Massachusetts;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chuan","family":"Zhou","sequence":"additional","affiliation":[{"name":"Pediatrics, University of Washington, School of Medicine, Seattle, Washington;"},{"name":"Center for Child Health, Behavior, and Development, Seattle Children\u2019s Research Institute, Seattle, Washington; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathryn B.","family":"Whitlock","sequence":"additional","affiliation":[{"name":"New Harmony Statistical Consulting, Clinton, Washington"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"5 Suppl","key":"b1","series-title":"J Neurosurg","first-page":"345","article-title":"Priorities for hydrocephalus research: report from a National Institutes of Health-sponsored workshop","volume":"107","author":"Williams MA","year":"2007","unstructured":"Williams MA, McAllister JP, Walker ML,  Priorities for hydrocephalus research: report from a National Institutes of Health-sponsored workshop. 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