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Prevention of Cerebrospinal Fluid (CSF) Shunt Infections

Award Number: R01NS101029
ORGANIZATION: NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 08/15/2020
PERIOD OF PERFORMANCE END DATE: 12/31/2023

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Prevention of Cerebrospinal Fluid (CSF) Shunt Infections - PROJECT SUMMARY Cerebrospinal fluid (CSF) shunt placement allows children with hydrocephalus, a common cause of neurological disability in children, to survive and avoid ongoing brain injury. However, CSF shunts can frequently require surgical revision; and with each subsequent CSF shunt surgery, the risk of CSF shunt infection increases. The burden to children, families, and the healthcare system of over 2,000 CSF shunt infections annually in terms of costs, morbidity over the life span, and quality of life are substantial and preventable. Two novel peri-operative techniques have emerged as recent advances to prevent CSF shunt infections: intrathecal instillation of broad spectrum antibiotics into the shunt during surgery, and the use of antibiotic impregnated shunt tubing, a more widespread, but expensive and controversial technique. The overall objective of this proposal is to determine the comparative effectiveness of intrathecal antibiotics and antibiotic impregnated shunt tubing in the prevention of CSF shunt infection. Compared to a clinical trial, use of large databases to study relatively uncommon events permits us to capitalize upon the existence of comprehensive information about large numbers of diverse patients for efficient analyses. The Pediatric Health Information System + (PHIS+) database includes detailed administrative, laboratory, microbiology, and radiology data for 6 large pediatric neurosurgical centers from 2007 to 2012; and PHIS+ includes over 6,900 CSF shunt surgeries, with over 1,600 receiving intrathecal antibiotics, over 1,245 receiving antibiotic-impregnated shunt tubing, and over 2,700 receiving prophylactic intravenous antibiotics alone (standard care). Specific Aim 1 will compare the risk of infection following the use of intrathecal antibiotics, antibiotic impregnated shunt tubing, and standard care during CSF shunt surgery. The independent association of each novel technique compared to standard care, after adjusting for patient and procedure risk factors, with subsequent CSF shunt infection will be determined. We will also examine complications, length of stay, and readmissions. Specific Aim 2 will determine the changes in infecting organism and patterns of antimicrobial resistance following the use of intrathecal antibiotics, antibiotic impregnated shunt tubing, and standard care during CSF shunt surgery. Specific Aim 3 will evaluate the cost-effectiveness of using intrathecal antibiotics, antibiotic impregnated shunt tubing, and standard care during CSF shunt surgery for the prevention of CSF shunt infection using cost data from PHIS+. This proposal will rapidly fill a critical knowledge gap in prevention of CSF shunt infection, addresses a critical healthcare-associated infection, and its findings will rapidly be available for widespread dissemination.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2024 ( Subtotal = $0 )
2024	2022	CHILDREN'S HOSPITAL LOS ANGELES	4650 W SUNSET BLVD	LOS ANGELES	CA	90027	LOS ANGELES	USA	Extramural Research Programs in the Neurosciences and Neurological Disorders	000	5	5/17/2024	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2023 ( Subtotal = $0 )
2023	2020	CHILDREN'S HOSPITAL LOS ANGELES	4650 W SUNSET BLVD	LOS ANGELES	CA	90027	LOS ANGELES	USA	Extramural Research Programs in the Neurosciences and Neurological Disorders	001	4	11/21/2022	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$250,134
2023	2019	SEATTLE CHILDREN'S HOSPITAL	4800 SAND POINT WAY NE	SEATTLE	WA	98105	KING	USA	Extramural Research Programs in the Neurosciences and Neurological Disorders	000	2	11/21/2022	NON-COMPETING CONTINUATION	-$250,134
														Subtotal = $0

Issue Date FY: 2022 ( Subtotal = $277,783 )
2022	2022	CHILDRENS HOSPITAL LOS ANGELES	4650 SUNSET BLVD	LOS ANGELES	CA	90027	LOS ANGELES	USA	Extramural Research Programs in the Neurosciences and Neurological Disorders	000	5	12/6/2021	NON-COMPETING CONTINUATION	$250,004
2022	2022	CHILDRENS HOSPITAL LOS ANGELES	4650 SUNSET BLVD	LOS ANGELES	CA	90027	LOS ANGELES	USA	Extramural Research Programs in the Neurosciences and Neurological Disorders	001	5	3/24/2022	NON-COMPETING CONTINUATION	$27,779
														Subtotal = $277,783

Issue Date FY: 2021 ( Subtotal = $0 )
2021	2020	CHILDRENS HOSPITAL LOS ANGELES	4650 SUNSET BLVD	LOS ANGELES	CA	90027	LOS ANGELES	USA	Extramural Research Programs in the Neurosciences and Neurological Disorders	003	4	5/7/2021	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$249,665
2021	2020	CHILDRENS HOSPITAL LOS ANGELES	4650 SUNSET BLVD	LOS ANGELES	CA	90027	LOS ANGELES	USA	Extramural Research Programs in the Neurosciences and Neurological Disorders	001	4	12/21/2020	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$589,236
2021	2020	SEATTLE CHILDREN'S HOSPITAL	4800 SAND PT WAY NE	SEATTLE	WA	98105	KING	USA	Extramural Research Programs in the Neurosciences and Neurological Disorders	000	3	12/21/2020	NON-COMPETING CONTINUATION	-$589,236
2021	2020	CHILDRENS HOSPITAL LOS ANGELES	4650 SUNSET BLVD	LOS ANGELES	CA	90027	LOS ANGELES	USA	Extramural Research Programs in the Neurosciences and Neurological Disorders	005	4	5/10/2021	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	-$249,665
2021	2019	SEATTLE CHILDREN'S HOSPITAL	4800 SAND POINT WAY NE	SEATTLE	WA	98105	KING	USA	Extramural Research Programs in the Neurosciences and Neurological Disorders	002	2	5/7/2021	NON-COMPETING CONTINUATION	-$249,665
2021	2019	SEATTLE CHILDREN'S HOSPITAL	4800 SAND POINT WAY NE	SEATTLE	WA	98105	KING	USA	Extramural Research Programs in the Neurosciences and Neurological Disorders	004	2	5/10/2021	NON-COMPETING CONTINUATION	$249,665
														Subtotal = $0

Issue Date FY: 2020 ( Subtotal = $589,236 )
2020	2020	SEATTLE CHILDREN'S HOSPITAL	4800 SAND POINT WAY NE	SEATTLE	WA	98105	KING	USA	Extramural Research Programs in the Neurosciences and Neurological Disorders	000	3	3/23/2020	NON-COMPETING CONTINUATION	$589,236
														Subtotal = $589,236

Issue Date FY: 2019 ( Subtotal = $622,802 )
2019	2019	SEATTLE CHILDREN'S HOSPITAL	4800 SAND POINT WAY NE	SEATTLE	WA	98105	KING	USA	Extramural Research Programs in the Neurosciences and Neurological Disorders	000	2	3/25/2019	NON-COMPETING CONTINUATION	$622,802
														Subtotal = $622,802

Issue Date FY: 2018 ( Subtotal = $720,234 )
2018	2018	SEATTLE CHILDREN'S HOSPITAL	4800 SAND POINT WAY NE	SEATTLE	WA	98105	KING	USA	Extramural Research Programs in the Neurosciences and Neurological Disorders	000	1	4/13/2018	NEW	$720,234
														Subtotal = $720,234

Grand Total All Awards = $2,210,055

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Prevention of Cerebrospinal Fluid (CSF) Shunt Infections

Award Number: R01NS101029

ORGANIZATION: NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 08/15/2020

PERIOD OF PERFORMANCE END DATE: 12/31/2023

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