314 https://oamjms.eu/index.php/mjms/index Scientifc Foundation SPIROSKI, Skopje, Republic of Macedonia Open Access Macedonian Journal of Medical Sciences. 2022 Feb 15; 10(B):314-319. https://doi.org/10.3889/oamjms.2022.8251 eISSN: 1857-9655 Category: B - Clinical Sciences Section: Neurology Ventriculoperitoneal Shunt Infection: A Study about Age as a Risk Factor in Hydrocephalus Pediatrics Reza Akbar Bastian 1 * , Handoyo Pramusinto 1 , Endro Basuki 1 , Marianne Marianne 2 1 Department of Surgery, Division of Neurosurgery, Universitas Gadjah Mada, Yogyakarta, Indonesia; 2 Department of Pharmacology Pharmacy, Faculty of Pharmacy, Universitas Sumatera Utara, Medan, Indonesia Abstract BACKGROUND: Shunt infection is one of the dreaded and serious complications following ventriculoperitoneal shunt (VP shunt) insertion, especially in a pediatric population. Numerous risk factors have been identifed, particularly in developing countries, indicating that age may play an essential element in the pathogenesis of shunt infection, typically in patients <1-year-old. However, a few research demonstrate the inverse result. AIM: The purpose of this was to determine the relationship between age and shunt infection so that it can be taken into consideration when performing VP shunt insertion. METHODS: From January 2017 to December 2019, 98 pediatric patients with hydrocephalus who underwent VP shunt insertion were retrospectively reviewed to determine the relationship between age and shunt infection. We evaluated the microbiology results and management of shunt infection in patients with shunt infection. RESULTS: Fifteen (15.15%) of 98 patients developed shunt infection. Patients aged >3–6 months had a signifcantly increased risk of shunt infection (p = 0.04; RR = 4.15; CI 95% = 1.19–14.45). Staphylococcus aureus was the most frequently encountered pathogen in pediatric patients with shunt infection (53.3%), and the most common management for shunt infection was complete removal of the shunt and systemic antibiotics followed by re-insertion of the shunt after the cerebrospinal fuid was sterile (46.6%). CONCLUSION: We conclude that age, especially those aged >3–6 months, has a signifcantly higher risk of shunt infection in pediatric patients. Edited by: Branislav Filipović Citation: Bastian RA, Pramusinto H, Basuki E, Marianne M. Ventriculoperitoneal Shunt Infection: A Study about Age as a Risk Factor in Hydrocephalus Pediatrics. Open Access Maced J Med Sci. 2022 Feb 15; 10(B):314-319. https://doi.org/10.3889/oamjms.2022.8251 Keywords: Shunt infection; Hydrocephalus; Pediatric; Risk factors *Correspondence: Reza Akbar Bastian, Department of Surgery, Division of Neurosurgery, Universitas Gadjah Mada, Yogyakarta, Indonesia. E-mail: rzabastian@gmail.com Received: 16-Dec-2021 Revised: 29-Jan-2022 Accepted: 05-Feb-2022 Copyright: © 2022 Reza Akbar Bastian, Handoyo Pramusinto, Endro Basuki, Marianne Marianne Funding: This research did not receive any fnancial support Competing Interests: The authors have declared that no competing interests exist Open Access: This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial 4.0 International License (CC BY-NC 4.0) Introduction Management for pediatric hydrocephalus patients with ventriculoperitoneal shunt (VP shunt) insertion still has a high failure and complication rate [1], [2]. One of the most dreaded and serious complications following VP shunt is shunt infection [3]. Some studies report a varied incidence of shunt infection; there were 4.4% in Jakarta, Indonesia, 5.5% in Denmark, 15.5% in America, and 17.7% in Turkey [4], [5], [6], [7]. Pediatric patients tend to be more susceptible to shunt infections than adults, which can be caused by several factors, most commonly in patients <1-year-old, i.e., a perfectly underdeveloped immune system, premature age, exposure to potential pathogens, comorbid diseases, and other physiological factors [7], [8]. Another study, on the other hand, reports the opposite result. Braga et al. reported that patients over the age of 2 years are more vulnerable to infection [9], whereas other research found no correlation between age and shunt infection [10], [11]. Shunt infection has a wide impact on the patients, not only increasing morbidity and mortality but also increasing costs associated with re-admission, procedures related to shunt infection, intravenous administration of antibiotics within a specifed time period, and the new shunt system insertion, with an average treatment time of 7–21 days [12]. Thus, this study aimed to investigate whether there is a relation between the patient’s age at the time of VP shunt insertion and shunt infection, especially in neurosurgery patients. Methods This was a retrospective cohort study (historical cohort) in which exposure and disease had occurred before the study’s start. The variables of age risk factors during the placement VP shunt were measured through medical records. Population and sample From January 2017 until December 2019, this study included all pediatric patients with