The identification of risk factors and outcomes of cerebrospinal fluid shunt infections caused by carbapenem-resistant gram-negative bacteria in children: a retrospective cohort

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dc.authoridSahbudak Bal, Zumrut/0000-0001-9189-8220
dc.authoridGüner Özenen, Gizem/0000-0002-9725-7501
dc.contributor.authorOzenen, Gizem Guner
dc.contributor.authorBal, Zumrut Sahbudak
dc.contributor.authorBolat, Elif
dc.contributor.authorUmit, Zuhal
dc.contributor.authorBilen, Nimet M.
dc.contributor.authorArslan, Sema Yildirim
dc.contributor.authorTurhan, Tuncer
dc.date.accessioned2024-08-31T07:47:33Z
dc.date.available2024-08-31T07:47:33Z
dc.date.issued2024
dc.departmentEge Üniversitesien_US
dc.description.abstractOBJECTIVE Cerebrospinal fluid (CSF) shunt infections caused by gram-negative bacteria are difficult to treat given the limited treatment options and the emergence of carbapenem-resistant (CR) strains. This study aimed to evaluate the demographic and clinical characteristics of children with CSF shunt and external ventricular drain (EVD) infections caused by gram-negative bacteria, to identify the risk factors for acquiring CR CSF shunt infections, and to report on the clinical outcomes of these infections. METHODS A retrospective cohort study was designed to evaluate pediatric patients with CSF shunt and EVD infections caused by gram-negative bacteria between January 2013 and February 2023. RESULTS A total of 64 episodes in 50 patients were evaluated. There were 45 (70.3%) CSF shunt infections and 19 (29.7%) EVD infections. The median (range) ages were 1.4 years (9 months-17.5 years) for CSF shunt infection patients and 4.2 years (1 month-17 years) for EVD infection patients. The most common isolated gram-negative bacteria species in CSF shunt infections were Pseudomonas spp. (12, 26.7%), followed by Escherichia coli (11, 24.4%), Klebsiella pneumoniae (9, 20%), and Enterobacter cloacae (5, 11.1%). In EVD infections, the most common isolated gram-negative bacteria species were Acinetobacter spp. (6, 31.6%), followed by Pseudomonas spp. (4, 21.1%) and E. coli (3, 15.8%). The carbapenem resistance rate was 26.3% (n = 5) in EVD infections and 26.2% (n = 11) in CSF shunt infections. When risk factors for carbapenem resistance were evaluated for CSF shunt infections, prior carbapenem treatment and a prolonged hospital stay > 7 days were risk factors for the CR group (p = 0.032 and p = 0.042, respectively). In definitive treatment, colistin was statistically more commonly used in the CR group (p = 0.049). When outcomes were evaluated, the 30-day mortality rate (18.2% vs 0%) was higher in the CR group, without a significant difference (p = 0.064). CONCLUSIONS A prolonged hospital stay > 7 days and prior carbapenem exposure within 30 days were associated with CR shunt infections caused by gram-negative bacteria.en_US
dc.identifier.doi10.3171/2024.1.PEDS23363
dc.identifier.endpage601en_US
dc.identifier.issn1933-0707
dc.identifier.issn1933-0715
dc.identifier.issue6en_US
dc.identifier.pmid38489813en_US
dc.identifier.scopus2-s2.0-85195227859en_US
dc.identifier.scopusqualityQ1en_US
dc.identifier.startpage591en_US
dc.identifier.urihttps://doi.org/10.3171/2024.1.PEDS23363
dc.identifier.urihttps://hdl.handle.net/11454/104466
dc.identifier.volume33en_US
dc.identifier.wosWOS:001240534500012en_US
dc.identifier.wosqualityN/Aen_US
dc.indekslendigikaynakWeb of Scienceen_US
dc.indekslendigikaynakScopusen_US
dc.indekslendigikaynakPubMeden_US
dc.language.isoenen_US
dc.publisherAmer Assoc Neurological Surgeonsen_US
dc.relation.ispartofJournal of Neurosurgery-Pediatricsen_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıen_US
dc.rightsinfo:eu-repo/semantics/closedAccessen_US
dc.snmz20240831_Uen_US
dc.subjectCarbapenem Resistanceen_US
dc.subjectCerebrospinal Fluiden_US
dc.subjectGram -Negativeen_US
dc.subjectPediatricen_US
dc.subjectShunt Infectionen_US
dc.titleThe identification of risk factors and outcomes of cerebrospinal fluid shunt infections caused by carbapenem-resistant gram-negative bacteria in children: a retrospective cohorten_US
dc.typeArticleen_US

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