Reducing neurosurgical infections worldwide
Research led by Professor Roger Bayston has revolutionised the outcomes for patients receiving implantable devices such as a shunt for the treatment of hydrocephalus (fluid accumulation on the brain), by reducing the risk of infection thanks to technology that impregnates the device with antibiotics. He explains more here:
In the mid-1980s I started researching a way to modify catheters so that infections could be prevented rather than leaving clinicians to treat them when they occurred. This early work focused on the shunt used in treating hydrocephalus which drains fluid from the brain. This is one of the most common neurosurgical procedures in the world, but infection occurs in up to 15% of patients and is more common in newborns and children. This is an unacceptable number for such a serious complication that can lead to meningitis, extended hospital stays or even irreversible brain injury.
The underlying technology takes a device from a manufacturer and applies a chemical process that allows the material to become deadly to bacteria for up to three months. It essentially introduces antibiotic molecules into the material in a way that they can migrate freely to replace those removed from the surface by fluid. It is not a coating.
The technology was commercialised in 2003 as Bactiseal® catheters. These shunts are approved by the FDA (US Food and Drug Administration) and are now widely used across 66 countries. They account for 77% of catheters used annually in hydrocephalus operations in the UK, saving the NHS £1m for every 100 used. Infection rates worldwide have been reduced by up to 70% and it has become the standard of care in the United States, where it has averted 250 deaths and 5,500 operations every year.
A seven-year study, funded by the National Institute for Health Research (NIHR) and published in The Lancet, involved more than 1600 patients with hydrocephalus across 21 UK neurosurgery centres and showed Bactiseal® shunts reduced the infection rate from 6% to 2%. If used in all new patients this would save the NHS around £7m per year, taking into account the costs associated with shunt infections, including hospital stays, drugs and further surgery.
"I’ll never forget being visited by a German student who told me that the technology saved her brother’s life. Research is always exciting but especially when it achieves its objectives and has a beneficial impact on people who need it. "
In some countries, people with traumatic brain injury are now at risk of serious life-threatening brain infections from multi-drug-resistant bacteria that colonise the catheters used to manage the condition. Our existing technology has now been modified to make the catheters kill even the most resistant bacteria, and tests are under way in collaboration with colleagues in the University of Bristol to bring this to clinical use.
I’ll never forget being visited by a German student who told me that the technology saved her brother’s life. Research is always exciting but especially when it achieves its objectives and has a beneficial impact on people who need it.
It was a highlight to be awarded the Lifetime Contribution Award from hydrocephalus charity ShineCharity and I’m proud of our team member Dr Katherine Belfield for receiving an award from the NHS Clinical Research Network for public involvement in research.
We are now looking at applying the same technique to urinary catheters, as 450,000 people in the UK use these long-term, so we hope to be able to reduce recurrent bladder and kidney infections to help improve their lives and prevent complications occurring such as sepsis. A large clinical trial funded by NIHR is due to take place later in 2021 and we’re also planning to use the technology in dialysis for people with kidney failure, where again serious infections are related to bacteria living inside the catheter.
The groups of patients this research-led innovation is helping are ones who are already prone to complications so anything we can do to minimise their risk of infection is worthwhile. Using our technology to improve the lives of those with life-changing conditions is immensely rewarding and is what spurs us on.
Roger Bayston is Professor of Surgical Infection in the Faculty of Medicine & Health Sciences