A randomized trial of ceftriaxone versus trimethoprim-sulfamethoxazole to prevent ventriculoperitoneal shunt infection
Farideh Nejat, Parvin Tajik, Mostafa El Khashab, Syed Shuja Kazmi, Ghamar Taj Khotaei, Shahrzad Salahesh
Departments of Neurosurgery, Children’s Hospital Medical Center and Epidemiology and Biostatistics, School of Public Health, Medical Sciences/University of Tehran, Tehran, Iran; Department of Neurosurgery, Children’s Medical Center, Dallas, Texas, USA; and Department of Infectious Diseases, Children’s Hospital Medical Center, Medical Sciences/University of Tehran, Tehran, Iran
Received: May 1, 2006 Revised: December 2, 2006 Accepted: January 22, 2007
Background and purpose:
Shunt infection represents a particularly morbid condition, which can also result in mortality. In order to decrease the high morbidity and mortality rates, prevention is an essential step. The purpose of this study was to compare the prophylactic use of ceftriaxone and trimethoprim-sulfamethoxazole (SXT) for the prevention of ventriculoperitoneal (VP) shunt infection.
In this prospective, single-institution, randomized clinical trial, 107 children with hydrocephalus and an indication for shunting were randomly assigned to prophylaxis with ceftriaxone (n = 50) or SXT (55), each administered as a single dose during anesthesia and two divided doses postoperatively. Patients were followed up for at least one year.
The mean age of patients was 15 months, and 85% were aged 6 months or younger. During the first postoperative year, meningitis occurred in 13.5% of patients receiving ceftriaxone and 14.5% of the SXT group, with no statistically significant difference between the groups. Younger age, presence of cerebrospinal fluid leakage and aqueductal stenosis as a cause of hydrocephalus showed significant correlation with meningitis occurrence on univariate analysis. However, only the latter 2 factors were associated with meningitis on multivariate analysis. The risk of shunt infection did not correlate with the gender of the patient, time of VP shunt surgery, or duration of hospitalization for shunting.
Ceftriaxone and SXT showed similar efficacy in preventing shunt infection. Cerebrospinal fluid leakage before or after VP shunt placement and aqueductal stenosis were independent risk factors for meningitis after VP shunt.
Antibiotic prophylaxis; Ceftriaxone; Meningitis; Trimethoprim-sulfamethoxazole combination; Ventriculoperitoneal shunt
J Microbiol Immunol Infect. 2008;41:112-117.