CSF shunt infections are extremely difficult to treat, resulting in prolonged hospitalizations, repeated shunt revision surgeries, and re-infection at rates as high as 25 percent. Our understanding of appropriate treatment of CSF shunt infection is limited and, as a result, management is highly variable. A recent National Institutes of Health (NIH) workshop highlighted a need to optimize treatment of CSF shunt infection and prevent CSF shunt re-Infection. As a pediatrician who cares for children in the inpatient setting (pediatric hospitalist), I frequently care for children with CSF shunt infection, hydrocephalus and other neurodevelopmental disorders. The research and career development aims of this proposal will focus on the conduct of multicenter longitudinal studies, which are necessary to generate adequate sample sizes to study clinical problems in children with neurodevelopmental disorders. Central to the proposed project is the Hydrocephalus Clinical Research Network (HCRN), a philanthropically-funded, centrally coordinated research effort between four pediatric neurosurgical hospitals. My affiliation with the HCRN offers a unique opportunity for a prospective, multicenter study of CSF shunt Infection treatment with adequate sample sizes. My career development aims Include the following: 1) expand my existing skills in data acquisition and management, 2) expand my existing skills In study design, analysis, and interpretation of results, 3) learn how to measure quality of life and psychometrics to assess long-term outcomes for children with neurodevelopmental disorders, 4) learn neurobiology methodologies to better understand emerging basic neuroscience findings, and 5) develop expertise In conducting multicenter studies. These alms will facilitate my overarching career goal- to transition to an independent physician-scientist capable of performing rigorous multicenter studies needed to improve the evidence base of Inpatient health care delivered to children with neurodevelopmental disorders. The central hypothesis of the proposed project is that variation in medical and surgical decision-making in the treatment of CSF shunt infection results in different rates of shunt re-infections.
Specific Aims i nclude: 1) Identify patient risk factors associated with CSF shunt infection, and 2) determine the association of intravenous antibiotic duration for treatment of CSF shunt infection with CSF shunt re-infection and 3) design a multicenter randomized controlled trial for the treatment of CSF shunt infection in the HCRN. Public Health Relevance: Children with hydrocephalus have a neurodevelopmental disorder whose principal treatment is cerebrospinal fluid (CSF) shunt placement. Shunts often require surgical revision which increases the risk of infection. CSF shunt infections lead to prolonged hospitalizations, high expenditures, repeated shunt revision surgeries, and re-infection at high rates. A recent NIH-sponsored workshop called for renewed research in hydrocephalus, including a need to optimize treatment of CSF shunt infection and prevent CSF shunt re-infection.
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