An innovative solution used to prevent common brain infections in patients having surgery for hydrocephalus has been found to significantly reduce infection rates according to a report published in The Lancet today (12 September 2019).
Hydrocephalus is a build-up of fluid on the brain. The excess fluid puts pressure on the brain, which can damage it. Approximately one out of every 500 babies is born with hydrocephalus, making it the most common reason for brain surgery in children.
Babies born with hydrocephalus (congenital) and adults or children who develop it (acquired) usually need prompt treatment to reduce the pressure on their brain. This is usually done with a shunt.
During surgery, a thin tube called a shunt is implanted in the brain. The excess cerebrospinal fluid (CSF) in the brain flows through the shunt to drain into the abdominal cavity where is absorbed. Approximately 1300 new shunts (UK shunt registry) are inserted in the UK each year.
Unfortunately, shunt infection affects up to 15% of patients having shunt surgery, and is more common in children and neonates. Shunt infection is a serious complication that can lead to meningitis, weeks in hospital, prolonged antibiotics, the need for further surgery and irreversible brain injury.
A team of scientists from the University of Nottingham, led by Professor of Surgical Infection Roger Bayston, developed a novel process (Bactiseal®) that allows brain shunts to be impregnated with antibiotics during manufacture.
A team of researchers from the University of Liverpool, Alder Hey Children's NHS Foundation Trust and The Walton Centre NHS Foundation Trust conducted the largest - ever clinical trial for hydrocephalus to test the infection-reducing properties of Bactiseal®. The BASICS trial (British Antibiotic and Silver Impregnated Catheters for ventriculoperitoneal Shunts) was funded by the National Institute for Health Research (NIHR), and cost £2.3M. Over 1600 patients with hydrocephalus took part, across 21 UK neurosurgery centres. The study took seven years (2012-2019) to complete.
The BASICS trial compared antibiotic and silver shunts to standard shunts (without antibiotic or silver coating). The results showed that antibiotic shunts reduce the infection rate from 6% to 2% and saved the NHS approximately £130K per infection averted. If the antibiotic shunts were used in all new patients, this would save the NHS approximately 7 million pounds per year.
The Chief investigators were Professor Conor Mallucci, Paediatric Neurosurgeon at Alder Hey Children's Hospital Trust, and Michael Jenkinson, Reader in Neurosurgery at the University of Liverpool and Consultant Neurosurgeon at The Walton Centre. The study was co-ordinated by Professor Carrol Gamble and run by the University of Liverpool's Clinical Trials Research Centre.
Conor Mallucci, said: "The results of our trial will have an impact on national and international hydrocephalus guidelines and policy. Using these antibiotic shunts will not only reduce potential harm to our patients but are also cost effective and should save Healthcare providers millions of pounds avoiding countless unnecessary days in hospital.'
Michael Jenkinson, said: "The BASICS study shows that antibiotic shunts reduce the risk of infection for all patients having shunt surgery for hydrocephalus. If we use antibiotic shunts routinely we really can 'get it right first time' by avoiding harm and delivering better outcomes for all our patients."
Roger Bayston, said: "The antibiotic shunts have now been shown in a well-designed randomised controlled trial to significantly reduce infection in hydrocephalus shunts. This is a major step forward in treatment of this condition, which can affect newborn babies and adults alike, and will reduce the need for surgery and for antibiotic treatment and will save heathcare costs."
The full paper, entitled 'Antibiotic or silver versus standard ventriculoperitoneal shunts (BASICS): a multicentre, single-blinded, randomised trial and economic evaluation', can be found on The Lancet website once the embargo has lifted.
Notes to Editors
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About the University of Liverpool @LivUniNews
Founded in 1881 as the original 'red brick', the University of Liverpool is one of the UK's leading research institutions with an annual turnover of £545.7 million, including £95.6 million. Consistently ranked in the top 200 universities worldwide, we are a member of the prestigious Russell Group of the UK's leading research universities.
About The Walton Centre NHS Foundation Trust @WaltonCentre
The Walton Centre NHS Foundation Trust is the only hospital trust in the UK specialising in neurology, neurosurgery and pain services. Although the majority of patients come from Merseyside, Cheshire, North Wales, Lancashire and the Isle of Man, for some specialist treatments of complex disorders we see patients from all parts of the country, referred by their GPs or other neurologists, neurosurgeons and pain clinicians.
The Trust has been rated as 'Outstanding' by the Care Quality Commission twice. The independent regulator of all health and social care services in England published its first rating on Friday 21 October 2016, following announced and unannounced inspection visits to the Trust in April 2016. The second was announced Monday 19 August 2019 after inspections in March and April 2019.
About Alder Hey Children's NHS Foundation Trust @AlderHey
Alder Hey Children's NHS Foundation Trust provides care for over 330,000 children and young people every year. Alder Hey delivers clinical excellence for all children, for routine illnesses as well as very complex and rare conditions.
One of four stand-alone children's hospitals in the UK, it is a national centre for neuro and craniofacial surgery, a regional centre for burns injuries and a Centre of Excellence for children with cancer, heart, spinal and brain disease. The Trust is one of only four epilepsy surgical centres in the UK and one of only two accredited major trauma centres in the North West. Alder Hey is also a respiratory Extracorporeal Membrane Oxygenation (ECMO) surge centre and is the referral centre for the treatment of congenital heart defects in North West England, North Wales and Isle of Man. It became the first UK Centre of Excellence for Childhood Lupus in 2010.
Alder Hey is the first accredited Investing in Children hospital in the UK. It has a dedicated patient experience programme which includes the award winning Alder Hey Arts involving music therapy, dance programmes, storytelling and animation projects. It is also one of a few hospitals to have a Children and Young Person's Forum.
Alder Hey opened a new hospital 'Alder Hey in the Park' in 2015. Europe's first hospital in a park, the new facility provides a purpose-built, unique and world class healing environment for children and young people.
Alder Hey is supported by The Alder Hey Children's Charity which aims to raise vital funds for lifesaving equipment, research projects and patient experience initiatives.
About The University of Nottingham @UniofNottingham
The University of Nottingham is a research-intensive university with a proud heritage, consistently ranked among the world's top 100. Studying at the University of Nottingham is a life-changing experience and we pride ourselves on unlocking the potential of our 44,000 students - Nottingham was named both Sports and International University of the Year in the 2019 Times and Sunday Times Good University Guide, was awarded gold in the TEF 2017 and features in the top 20 of all three major UK rankings.
We have a pioneering spirit, expressed in the vision of our founder Sir Jesse Boot, which has seen us lead the way in establishing campuses in China and Malaysia - part of a globally connected network of education, research and industrial engagement. We are ranked eighth for research power in the UK according to REF 2014. We have six beacons of research excellence helping to transform lives and change the world; we are also a major employer and industry partner - locally and globally.