Role of intrathecal and topical vancomycin in prevention of ventriculoperitoneal shunt infections

The objective of this study is to assess the role of intrathecal and topical vancomycin in the prevention of ventriculoperitoneal shunt infection. Infections of the ventriculoperitoneal (VP) shunt are a frequent consequence of shunt surgery. Different strategies, and protocols in addition to prophylactic intravenous antibiotic administration have been described to limit the infection rate, but the burden still remains high. The use of intrathecal Vancomycin along with topical application can be implemented as an additional measure to limit shunt-related infections. The study includes 105 patients who underwent ventriculoperitoneal shunt insertions for different reasons. Apart from the standard operative protocols used for shunt surgeries, intraoperatively intrathecal and topical vancomycin were administered to all the patients. Postoperatively, all the patients were followed for three months to assess shunt-related infections. The study showed that the infection rate after administration of intrathecal and topical Vancomycin was found to be low, which is 4.7%, which shows a reduction of 5.8% from our baseline infection rate of 10.5%. We also found that patients having tuberculous meningitis were more at risk of developing shunt-related infections, the p-value being significant (0.001*). Therefore we conclude that as part of a standardized shunt operation routine, Intrathecal and topical vancomycin treatment may be an appropriate option for preventing pediatric shunt infections.