Effectiveness of subgaleal topical vancomycin powder in reducing infection rates and shunt revisions in pediatric ventriculoperitoneal shunt surgery: a promising prophylactic approach

Abstract

Purpose This study aims to evaluate the effectiveness of two prophylactic strategies in preventing shunt infections in pediatric patients undergoing ventriculoperitoneal shunt surgery. Methods This retrospective study included pediatric patients who underwent ventriculoperitoneal shunt surgery between 2017 and 2024. Patients were divided into two groups based on the prophylactic method used: Group 1 (VS) where the shunt was washed with vancomycin solution before placement, and Group 2 (TVP) where vancomycin powder was applied to the subgaleal and subcutaneous tissues after shunt placement. Data collected included age, gender, preoperative CRP values, operation length, hospitalization duration, wound site problems, and rates of early (within 3 days) and late (within 36 months) postoperative infections and shunt revisions. Results Data from 56 pediatric patients were analyzed. The TVP group had significantly lower rates of early postoperative infections compared to the VS group (3.3% vs. 26.9%, p < 0.05). Late postoperative infections were also lower in the TVP group (3.3% vs. 30.7%, p < 0.05). Shunt revision was required in 26.9% of patients in the VS group, but none in the TVP group (p < 0.05). Wound site problems were a critical factor, with all patients experiencing wound site infections also developing early postoperative infections (p < 0.05). Conclusion The use of subgaleal topical vancomycin powder is a promising prophylactic method in ventriculoperitoneal shunt surgery, particularly for pediatric patients who are prone to skin problems, as it effectively avoids systemic toxic effects while reducing infection rates and the need for shunt revisions.