Efficacy and Cost-Effectiveness of Topical Vancomycin Powder in Preventing Pediatric Ventriculoperitoneal Shunt Infections Across Different Etiologies

Summary

Objectives * Primary: * To measure the reduction in VP shunt infection rates using topical vancomycin powder. * Secondary: * To compare efficacy across different Etiological Strata (Congenital, Post-hemorrhagic, post-inflammatory). * To analyze the microbiological profile of failed cases. * To compare the "Time-to-Infection" and shunt survival rates between the study and control groups using Kaplan-Meier analysis. * To evaluate the cost-effectiveness of TVP compared to the standard management and historical AIC data

Timeline

Start

2026-05

Primary completion

2027-05

Completion

2027-12

Publications

• Background Xu SJ, Liu XL, Shi JP, Shi JX. The Effect of Topical Vancomycin Powder Application on the Rate of Intervertebral Fusion Following Lumbar Fusion: A Retrospective Study. World Neurosurg. 2024 May;185:e1216-e1223. doi: 10.1016/j.wneu.2024.03.059. Epub 2024 Mar 20.
• Background Khunchamnan S, Sopchokchai I, Sawanyawisuth K, Kitkhuandee A. An Antibiotic Prophylaxis for Prevention of Ventriculoperitoneal Shunt Infection Using Intraventricular Injection and Shunt Soaking with Vancomycin and Gentamicin. Antibiotics (Basel). 2026 Jan 5;15(1):60. doi: 10.3390/antibiotics15010060.
• Background Abdullah KG, Chen HI, Lucas TH. Safety of topical vancomycin powder in neurosurgery. Surg Neurol Int. 2016 Dec 5;7(Suppl 39):S919-S926. doi: 10.4103/2152-7806.195227. eCollection 2016.
• Background Ho AL, Cannon JGD, Mohole J, Pendharkar AV, Sussman ES, Li G, Edwards MSB, Cheshier SH, Grant GA. Topical vancomycin surgical prophylaxis in pediatric open craniotomies: an institutional experience. J Neurosurg Pediatr. 2018 Dec 1;22(6):710-715. doi: 10.3171/2018.5.PEDS17719. Epub 2018 Aug 24.
• Background Youn SB, Hwang G, Kim HG, Kang JS, Kim HC, Oh SH, Kim MK, Chung BS, Rhim JK, Sheen SH. Intrawound Vancomycin Powder Application for Preventing Surgical Site Infection Following Cranioplasty. J Korean Neurosurg Soc. 2023 Sep;66(5):536-542. doi: 10.3340/jkns.2023.0024. Epub 2023 Apr 10.
• Background Krause M, Mahr CV, Schob S, Nestler U, Wachowiak R. Topical instillation of vancomycin lowers the rate of CSF shunt infections in children. Childs Nerv Syst. 2019 Jul;35(7):1155-1157. doi: 10.1007/s00381-019-04185-1. Epub 2019 May 20.
• Background Peng Z, Lin X, Kuang X, Teng Z, Lu S. The application of topical vancomycin powder for the prevention of surgical site infections in primary total hip and knee arthroplasty: A meta-analysis. Orthop Traumatol Surg Res. 2021 Jun;107(4):102741. doi: 10.1016/j.otsr.2020.09.006. Epub 2020 Nov 27.
• Background Strom RG, Pacione D, Kalhorn SP, Frempong-Boadu AK. Lumbar laminectomy and fusion with routine local application of vancomycin powder: decreased infection rate in instrumented and non-instrumented cases. Clin Neurol Neurosurg. 2013 Sep;115(9):1766-9. doi: 10.1016/j.clineuro.2013.04.005. Epub 2013 Apr 23.
• Background Kahle KT, Kulkarni AV, Limbrick DD Jr, Warf BC. Hydrocephalus in children. Lancet. 2016 Feb 20;387(10020):788-99. doi: 10.1016/S0140-6736(15)60694-8. Epub 2015 Aug 6.
• Background Javeed F, Mohan A, Wara UU, Rehman L, Khan M. Ventriculoperitoneal Shunt Surgery for Hydrocephalus: One of the Common Neurosurgical Procedures and Its Related Problems. Cureus. 2023 Feb 15;15(2):e35002. doi: 10.7759/cureus.35002. eCollection 2023 Feb.
• Background Grosfeld JL, Cooney DR. Inguinal hernia after ventriculoperitoneal shunt for hydrocephalus. J Pediatr Surg. 1974 Jun;9(3):311-5. doi: 10.1016/s0022-3468(74)80286-1. No abstract available.
• Background Kuruoglu T, Altun G, Kuruoglu E, Turan DB, Onger ME. Actions of N-acetylcysteine, daptomycin, vancomycin, and linezolid on methicillin-resistant Staphylococcus aureus biofilms in the ventriculoperitoneal shunt infections: an experimental study. Chin Neurosurg J. 2022 Jul 5;8(1):15. doi: 10.1186/s41016-022-00284-2.
• Background Bayston R, Ashraf W, Bhundia C. Mode of action of an antimicrobial biomaterial for use in hydrocephalus shunts. J Antimicrob Chemother. 2004 May;53(5):778-82. doi: 10.1093/jac/dkh183. Epub 2004 Mar 31.
• Background Darouiche RO. Treatment of infections associated with surgical implants. N Engl J Med. 2004 Apr 1;350(14):1422-9. doi: 10.1056/NEJMra035415. No abstract available.
• Background Hasanpour M, Rezaee H, Samini F, Keykhosravi E. Effects of Intraventricular Vancomycin Administration on the Prevention of Ventricular Shunt Infection. J Neurol Surg A Cent Eur Neurosurg. 2023 Jun 1. doi: 10.1055/a-2104-1461. Online ahead of print.
• Background Uysal E, Cine HS, Cakaloglu HC. Effectiveness of subgaleal topical vancomycin powder in reducing infection rates and shunt revisions in pediatric ventriculoperitoneal shunt surgery: a promising prophylactic approach. Childs Nerv Syst. 2024 Nov 26;41(1):3. doi: 10.1007/s00381-024-06672-6.
• Background Lee JK, Seok JY, Lee JH, Choi EH, Phi JH, Kim SK, Wang KC, Lee HJ. Incidence and risk factors of ventriculoperitoneal shunt infections in children: a study of 333 consecutive shunts in 6 years. J Korean Med Sci. 2012 Dec;27(12):1563-8. doi: 10.3346/jkms.2012.27.12.1563. Epub 2012 Dec 7.
• Background McGirt MJ, Zaas A, Fuchs HE, George TM, Kaye K, Sexton DJ. Risk factors for pediatric ventriculoperitoneal shunt infection and predictors of infectious pathogens. Clin Infect Dis. 2003 Apr 1;36(7):858-62. doi: 10.1086/368191. Epub 2003 Mar 18.

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