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Etiology, Incidence, and Risk Factors for Meningitis after Ventriculoperitoneal Shunt Procedures: A Multicenter Study

Published online by Cambridge University Press:  02 November 2020

Danilo Silva
Affiliation:
Centro Universitário de Belo Horizonte – UniBH;
Henrique Couto
Affiliation:
Centro Universitário de Belo Horizonte – UniBH;
Hoberdan Pereira
Affiliation:
Hospital Metropolitano Odilon Behrens – HOB
Gregory Lauar Souza
Affiliation:
Centro Universitário de Belo Horizonte – UniBH;
Andressa Silveira
Affiliation:
UniBH
Handerson Dias Duarte de Carvalho
Affiliation:
UniBH
Fernando Bracarense
Affiliation:
Centro Universitário de Belo Horizonte – UniBH;
Fernanda de Carvalho
Affiliation:
Centro Universitário de Belo Horizonte – UniBH;
Braulio Couto
Affiliation:
Centro Universitário de Belo Horizonte – UniBH;
Carlos Starling
Affiliation:
Vera Cruz Hospital
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Abstract

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Background: The ventriculoperitoneal shunt is the main procedure used for to treat communicating hydrocephalus. Surgical site infection associated with the shunt device is the most common complication and a cause of morbidity and mortality of related to the treatment. We sought to answer 3 questions: (1) What is the risk of meningitis after ventricular shunt operations? (2) What are the risk factors for meningitis? (3) What are the main microorganisms causing meningitis? Methods: We conducted a retrospective cohort study of patients undergoing ventricular shunt operations between July 2015 and June 2018 from 12 hospitals at Belo Horizonte, Brazil. Data were gathered by standardized methods defined by the CDC NHSN. Our sample size was 926, and we evaluated 26 preoperative and operative variables by univariate and multivariate analysis. Our outcome variables of interest were meningitis and hospital death. Results: In total, 71 cases of meningitis were diagnosed (risk, 7.7%; 95% CI, 6.1%–9.6%). The mortality rate among patients without infection was 10%, whereas hospital mortality of infected patients was 13% (P = .544). The 3 main risk factors for meningitis after ventricular shunt were identified by logistic regression model: age <2 years (OR, 3.20; P < .001), preoperative hospital stay >4 days (OR, 2.02; P = .007) and >1 surgical procedure, in addition to ventricular shunt (OR, 3.23; P = .043). Almost 1 of 3 of all patients was <2 years old (290, 31%). Also, 430 patients had >4 preoperative days (46%). Patients aged ≥2 years who underwent surgery 4 days after hospital admission had an increased risk of meningitis, from 4% to 6% (P = .140). If a patient <2 years old underwent surgery 4 or more days after hospital admission, the risk of meningitis increased from 9% to 18% (P = .026; Fig. 1). We built a risk index using the number of main risk factors based on a logistic regression model (0, 1, 2 or 3; Fig. 2). Conclusions:We identified 2 intrinsic risk factors for meningitis after ventricular shunt, age <2 years and multiple surgical procedures, and 1 extrinsic risk factor, the preoperative length of hospital stay.

Funding: None

Disclosures: None

Type
Poster Presentations
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.