Poor surgical outcomes following Paenibacillus infant infectious hydrocephalus

OBJECTIVE The authors previously identified Paenibacillus species in the CSF of 44% of infants presenting for neurosurgical evaluation with findings consistent with postinfectious hydrocephalus (PIH) in Eastern Uganda. Here, they sought to compare outcomes among hydrocephalic infants with and without Paenibacillus detection at the time of hydrocephalus surgery. METHODS In a prospective observational study of 189 infants with PIH who underwent a CSF diversion prior to 90 days of age, 78 had a positive CSF polymerase chain reaction result for Paenibacillus species (PP), and 111 had a negative result (PN). The primary outcome was diversion failure–free survival, defined as being alive without diversion failure at last patient contact. Secondary outcomes included overall survival and diversion success. RESULTS After a median follow-up period of 35.7 months, the primary outcome was observed in 42 PP patients (54%) and in 76 PN patients (68%) (adjusted hazard ratio [aHR] 2.45, 95% CI 1.42–4.22; p = 0.001). PP patients who underwent endoscopic diversion had a worse primary event rate (aHR 6.47, 95% CI 2.40–17.42; p < 0.001). Death from any cause occurred in 16 PP patients (21%) and 9 PN patients (8%) (aHR 3.47, 95% CI 1.44–8.37; p = 0.006). Diversion failure occurred in 28 PP patients (36%) and 29 PN patients (26%) (aHR 2.24, 95% CI 1.31–3.85; p = 0.003). CONCLUSIONS In this study, Paenibacillus detection in the CSF at the time of hydrocephalus surgery was associated with a significantly increased rate of the composite of diversion failure or death, death, and diversion failure, and was particularly increased for patients who had an endoscopic diversion.