Antibiotic prophylaxis and infection risk in pediatric ventriculoperitoneal shunt surgery: a systematic review and meta-analysis.

Ventriculoperitoneal (VP) shunt surgery is a common neurosurgical procedure in pediatrics, but it carries a significant risk of surgical site infections (SSIs). Antibiotic prophylaxis is widely used to prevent SSIs, but its efficacy in this context remains unclear. This systematic review and meta-analysis aimed to summarize the existing evidence on the effectiveness of antibiotic prophylaxis in reducing infection rates in pediatric patients undergoing VP shunt surgery. A comprehensive literature search was conducted in PubMed, EMBASE, Cochrane Library, Ovid, Google Scholar, and Quality Outcome Database (QOD), from 1975 to June 2025. We included randomized controlled trials (RCTs) or observational reporting infection rates after antibiotic prophylaxis in pediatric patients (< 18 years) undergoing VP shunt surgery. Two reviewers independently performed the screening, data extraction, and quality assessment. Infection risk was reported as risk ratio (RR) and 95% confidence interval (CI). Subgroup analyses were conducted according to antibiotic type and study design. Additionally, proportional meta-analysis was conducted for the antibiotic group. We included 11 studies, eight RCTs and three retrospective cohorts, comprising 2379 patients. The pooled rate of infection among patients receiving antibiotics was 6.3%. The use of prophylactic antibiotics significantly reduced the risk of infection (RR = 0.55, 95% CI 0.38 to 0.80, P = 0.0016). Subgroup analysis showed that vancomycin was associated with a significant reduction in infection (RR = 0.51, 95% CI 0.27 to 0.94, P = 0.03), while methicillin (P = 0.052) and other antibiotics (P = 0.09) were not.

conclusionThis systematic review and meta-analysis showed that antibiotic prophylaxis, particularly vancomycin, significantly reduced infection rates in pediatric patients undergoing VP shunt surgery. Given that most of the included studies were conducted before 2000 and that there was substantial heterogeneity in infection definitions as well as in the type, dose, duration, and route of antibiotic prophylaxis, the overall findings suggest a potential benefit; however, these results should be interpreted with caution and cannot be directly extrapolated to contemporary clinical practice. WHAT IS KNOWN: • Ventriculoperitoneal shunt infection is a major complication in pediatric hydrocephalus requiring effective antimicrobial prevention and treatment strategies. • Optimal antibiotic selection for reducing shunt infection remains debated across studies. WHAT IS NEW: • This meta-analysis suggests improved infection control outcomes with vancomycin-based strategies in VP shunt management. • Findings should be interpreted cautiously given study heterogeneity and limitations of available evidence.