J Korean Neurosurg Soc.  2021 Mar;64(2):297-308. 10.3340/jkns.2019.0219.

Systematic Review and Meta-Analysis of Antibiotic-Impregnated Shunt Catheters on Anti-Infective Effect of Hydrocephalus Shunt

• Zhou Wx
• Hou Wb
• Zhou C
• Yin Yx
• Lu St
• Liu G
• Fang Y
• Li Jw
• Wang Y
• Liu Ah
• Zhang Hj

• KMID: 2513861
• DOI: http://doi.org/10.3340/jkns.2019.0219

Abstract

Objective
: Shunt infection is a common complication while treating hydrocephalus. The antibiotic-impregnated shunt catheter (AISC) was designed to reduce shunt infection rate. A meta-analysis was conducted to study the effectiveness of AISCs in reduction of shunt infection in terms of age, follow-up time and high-risk patient population.
Methods
: This study reviewed literature from three databases including PubMed, EMBASE, and Cochrane Library (from 2000 to March 2019). Clinical studies from controlled trials for shunt operation were included in this analysis. A subgroup analysis was performed based on the patient’s age, follow-up time and high-risk population. The fixed effect in RevMan 5.3 software (Cochrane Collaboration) was used for this meta-analysis.
Results
: This study included 19 controlled clinical trials including 10105 operations. The analysis demonstrated that AISC could reduce the infection rate in shunt surgery compared to standard shunt catheter (non-AISC) from 8.13% to 4.09% (odds ratio [OR], 0.48; 95% confidence interval [CI], 0.40–0.58; p=0.01; I²=46%). Subgroup analysis of different age groups showed that AISC had significant antimicrobial effects in all three groups (adult, infant, and adolescent). Follow-up time analysis showed that AISC was effective in preventing early shunt infections (within 6 months after implant). AISC is more effective in high-risk population (OR, 0.24; 95% CI, 0.14–0.40; p=0.60; I²=0%) than in general patient population.
Conclusion
: The results of meta-analysis indicated that AISC is an effective method for reducing shunt infection. We recommend that AISC should be considered for use in infants and high-risk groups. For adult patients, the choice for AISC could be determined based on the treatment cost.

Keyword

Antibiotic-impregnated shunt catheters; Cerebrospinal fluid; Hydrocephalus; Infections

Figure

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  Fig. 1. Selection of studies based on inclusion criteria.

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  Fig. 2. Funnel plot to assess publication bias. A : A total of 19 studies, B : adult group, C : underage group, D : infant group, E : 0–3 months group, F : 4–6 months group, G : >6 months group, H : high-risk group. SE : standard error, RR : risk ratio, OR : odds ratio.

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  Fig. 3. Comprehensive analysis of anti-infection effect of AISC. OR : odds ratio, M-H : mantel-haenszel, CI : confidence interval, AISC : antibiotic-impregnated shunt catheter.

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  Fig. 4. Age-based subgroup analysis of the anti-infective effect of AISC. OR : odds ratio, M-H : mantel-haenszel, CI : confidence interval, AISC : antibiotic-impregnated shunt catheter.

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  Fig. 5. Anti-infective effect of AISC in subgroups with different follow-up time. OR : odds ratio, M-H : mantel-haenszel, CI : confidence interval, AISC : antibiotic-impregnated shunt catheter.

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  Fig. 6. Analysis of anti-infection effect of AISCs in high-risk subgroup. OR : odds ratio, M-H : mantel-haenszel, CI : confidence interval, AISC : antibiotic-impregnated shunt catheter.

Reference

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