Efficacy of antibiotic-impregnated shunt versus conventional shunts to reduce cerebrospinal fluid infections in children: A systematic review and meta-analysis

Hydrocephalus is among the most common pediatric conditions treated by neurosurgeons. An antibiotic-impregnated shunt (AIS) was designed to reduce the rate of shunt infections. The objective of this systematic review and meta-analysis was to assess the efficiency of AIS in reducing the rate of shunt infection compared with standard shunts (SSs). A systematic search of PubMed, EMBASE, Medline, Cochrane Library, TRIP Database, CINAHL and Google Scholar databases was performed. Eligible studies included observational studies and randomized controlled trials (RCT) that compared the effects of AIS and SS for preventing shunt infections in pediatric patients. Twelve observational studies and one RCT conducted from January 2005 through October 2019 involving 7,952 pediatric patients were included in the analysis. The use of AIS significantly decreased the risk of CRI [risk ratio (RR) 0.42; 95% confidence interval: 0.33 to 0.53; P<0.00001] with no statistical heterogeneity across the included studies (I(2)=42%). This analysis demonstrates that the use of AIS significantly reduces the risk of shunt infection in pediatric patients.