Reinfection after treatment of first shunt infection: a prospective observational cohort study
CSF shunt re-infection rates are approximately 2-3 fold higher following an initial infection. Data from 7 participating centers of the Hydrocephalus Clinical Research Network was used to evaluate how clinical management of initial CSF shunt infections affects reinfection rates. Overall shunt reinfection rate was 16%. Most (75%) initial shunt infections were treated with total shunt removal and EVD placement. Reinfection was not significantly associated with surgical approach and duration of intravenous antibiotic use. Rifampin use was independently associated with decreased infection risk. Non-modifiable risk factors (age, chronic comorbidities and number of revisions after initial infection) were independently associated with increased reinfection risk. Although not reaching statistical significance, surgical treatment other than total shunt removal at initial infection and non-ventriculoperitoneal shunt locations were associated with a higher hazard odds ratio of reinfection. These results indicate the need to standardize surgical and medical approaches to managing shunt infections. Study interpretation is limited by variations in definition of shunt infections and surgical practices of shunt management in non-HCRN institutions.