PRIMARY VENTRICULOPERITONEAL SHUNT INFECTION IN TERTIARY NEUROSURGICAL CENTER IN OMAN: A RETROSPECTIVE STUDY

Maya Al Salti, Dr. Mohammad Rafiq Khilji, Dr. Manoj Malviya, Dr. Neeraj Salhotra*, Amal Al Jabri

ABSTRACT

Objectives: To determine the incidence of primary ventriculoperitoneal (VP) shunt infection, causative organisms, underlying risk factors, and outcome in patients undergoing shunt surgery. Methods: This is a retrospective, single center, cohort review of all patients who developed primary VP shunt infection. This study was conducted from January 2010 to December 2016 in neurosurgical center at Khoula Hospital, a tertiary hospital in Oman. The primary outcome was shunt infection defined as positive cerebrospinal fluid culture that was associated with compatible symptoms and signs of central nervous system infection or shunt malfunction, surgical incision site infection requiring shunt reinsertion and intra-peritoneal pseudo-cyst formation. Patient with infection were determined and investigated for risk factors. Data was collected in Epi-Data sheet which was created with the help of Epi-Data Manager Program. Analysis was done using IMB SPSS statistics 25.0. Results: A primary VP shunt was inserted in 307 patients during the study period with 2.53 years mean duration of follow-up. Among 307 patients, 44 developed primary VP shunt infection with a rate of 14.3% with male to female ratio of 1:1. About half of the infections developed in patients aged less than one month. Among the infected cases, hydrocephalus due to myelomeningocele was the commonest indication (32%). More than half of the patients developed infection within three months post operation. There was no significant association among the factors examined and VP shunt infection. Coagulase negative staphylococcus was the commonest organism (38%) followed by Staphylococcus aureus (9%), gram negative organisms (18%), and polymicrobial gram-negative (16%). Multidrug resistance organisms account for eight isolates in which ESBL is the commonest. Modalities of treatment varied; (50%) were treated with one stage revision using external ventricular drainage which complicated by EVD related infection in 50%. The all-cause mortality was 18% with attributable mortality of 4.5%. Conclusions: The incidence of primary shunt infection in Khoula Hospital is within the international benchmark for this type of surgery. We describe a high rate of MDRO causing VP infection, this should trigger strict adherence to infection control practices in such high-risk surgery.

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