Antibiotic prophylaxis for patients with hydrocephalus shunts: a survey of pediatric dentistry and neurosurgery program directors.

A survey of antibiotic prophylaxis recommendations for patients with hydrocephalus shunts was sent to directors of advanced programs in pediatric dentistry and neurosurgery. Recommendations were sought for patients with ventriculoperitoneal (VP) or ventriculoatrial (VA) shunts who were to receive dental care. Most respondents believed that shunt infection (SI) was related infrequently to dental procedures. Pediatric dentists believed that 5.2% of infected VA shunts were related to dental procedures, while neurosurgeons believed the rate to be 3.0% (P < 0.05). There was no difference in perceived risk for VP shunts. Except for the equal risk associated with extractions, pediatric dentists were significantly more likely than neurosurgeons to recommend chemoprophylaxis for patients with VA shunts undergoing invasive dental procedures (P < 0.05). They were more likely to agree with neurosurgeons when VP shunts were involved. Except for the equal risk associated with dental prophylaxis, pediatric dentists and neurosurgeons believed VA shunt patients were at greater risk for SI than VP shunt patients (P < 0.05). Pediatric dentists were significantly more likely to ascribe SI to streptococcal organisms, and recommended penicillin for prophylaxis for both VA and VP shunts (P < 0.01 and 0.025, respectively). Although neurosurgeons believed that staphylococcal organisms were most likely to be responsible for SI (P < 0.001), 60% still recommended using penicillin for shunt prophylaxis following dental procedures.