Reducing the incidence of infection in pediatric cerebrospinal fluid shunt operations.

We reviewed our experience with shunt implantation during two time periods. From June 1985 to December 1990, 201 children with hydrocephalus underwent 382 operations. Among these children 36 (18%) developed a proven shunt infection, with an incidence rate per procedure of 9.4%. As a result of this study, a new effective protocol for shunt procedures involving modifications to the perioperative (antibiotic prophylaxis) and intraoperative management (meticulous surgical technique, complete shunt revision) of children undergoing initial shunt implantation or revision was initiated. With this new protocol 75 children underwent a total of 112 procedures between January 1991 and December 1995. The incidence of shunt infection decreased, with a per patient rate of 8% and a per procedure rate of 5.3%. The majority of infections in our study were caused by Staphylococcus epidermidis, which was found in 22 (52.3%) patients.