Antibiotic-Impregnated Catheters for Ventriculoperitoneal Shunt in Neonates and Infants: A Systematic Review and Meta-Analysis.

Abstract

Ventriculoperitoneal shunt (VPS) is the standard treatment for hydrocephalus in neonates and infants, but is commonly complicated by shunt infections. Antibiotic-impregnated catheters (AICs) have been introduced to mitigate infection risk; however, their effectiveness remains uncertain. We conducted a systematic review and meta-analysis comparing outcomes in neonates and infants who underwent VPS with and without AICs. Primary outcomes included shunt infection risk, time to first infection, and infections caused by gram-positive cocci and gram-negative rods. Pooled odds ratios (ORs), mean differences, and 95% confidence intervals (CIs) were calculated using random-effects models. Seven studies encompassing 1,009 patients were included. The use of AICs was associated with a significant three-fold reduction in overall shunt infection risk compared to standard catheters (OR 0.27; 95% CI 0.15-1.03; P < 0.01; I² = 0%). Subgroup analysis showed significant infection risk reduction in infants (OR 0.29; 95% CI 0.12-0.67; P = 0.004) and neonates (OR 0.26; 95% CI 0.11-0.62; P < 0.01). AICs led to a significant decrease in gram-positive cocci infections (OR 0.20; 95% CI 0.06-0.69; P = 0.01) but not gram-negative rod infections. The time to first infection was significantly prolonged in the AIC group (mean difference 4.6 months; 95% CI 2.2-6.9; P < 0.01). Lower infection risk persisted at 6 months and beyond. AICs substantially reduce infection risk and delay infection onset in neonates and infants undergoing VPS, particularly for gram-positive bacteria. Routine use is recommended.