Book contents
- Frontmatter
- Contents
- Preface
- Contributors
- Part I Clinical Syndromes – General
- Part II Clinical Syndromes – Head and Neck
- Part III Clinical Syndromes – Eye
- Part IV Clinical Syndromes – Skin and Lymph Nodes
- Part V Clinical Syndromes – Respiratory Tract
- Part VI Clinical Syndromes – Heart and Blood Vessels
- Part VII Clinical Syndromes – Gastrointestinal Tract, Liver, and Abdomen
- Part VIII Clinical Syndromes – Genitourinary Tract
- Part IX Clinical Syndromes – Musculoskeletal System
- Part X Clinical Syndromes – Neurologic System
- 73 Bacterial Meningitis
- 74 Aseptic Meningitis Syndrome
- 75 Acute Viral Encephalitis
- 76 Intracranial Suppuration
- 77 Spinal Epidural Abscess: Diagnosis and Management
- 78 Myelitis and Peripheral Neuropathy
- 79 Reye's Syndrome
- 80 Progressive Multifocal Leukoencephalopathy
- 81 Cerebrospinal Fluid Shunt Infections
- 82 Prion Diseases
- Part XI The Susceptible Host
- Part XII HIV
- Part XIII Nosocomial Infection
- Part XIV Infections Related to Surgery and Trauma
- Part XV Prevention of Infection
- Part XVI Travel and Recreation
- Part XVII Bioterrorism
- Part XVIII Specific Organisms – Bacteria
- Part XIX Specific Organisms – Spirochetes
- Part XX Specific Organisms – Mycoplasma and Chlamydia
- Part XXI Specific Organisms – Rickettsia, Ehrlichia, and Anaplasma
- Part XXII Specific Organisms – Fungi
- Part XXIII Specific Organisms – Viruses
- Part XXIV Specific Organisms – Parasites
- Part XXV Antimicrobial Therapy – General Considerations
- Index
81 - Cerebrospinal Fluid Shunt Infections
from Part X - Clinical Syndromes – Neurologic System
Published online by Cambridge University Press: 05 March 2013
- Frontmatter
- Contents
- Preface
- Contributors
- Part I Clinical Syndromes – General
- Part II Clinical Syndromes – Head and Neck
- Part III Clinical Syndromes – Eye
- Part IV Clinical Syndromes – Skin and Lymph Nodes
- Part V Clinical Syndromes – Respiratory Tract
- Part VI Clinical Syndromes – Heart and Blood Vessels
- Part VII Clinical Syndromes – Gastrointestinal Tract, Liver, and Abdomen
- Part VIII Clinical Syndromes – Genitourinary Tract
- Part IX Clinical Syndromes – Musculoskeletal System
- Part X Clinical Syndromes – Neurologic System
- 73 Bacterial Meningitis
- 74 Aseptic Meningitis Syndrome
- 75 Acute Viral Encephalitis
- 76 Intracranial Suppuration
- 77 Spinal Epidural Abscess: Diagnosis and Management
- 78 Myelitis and Peripheral Neuropathy
- 79 Reye's Syndrome
- 80 Progressive Multifocal Leukoencephalopathy
- 81 Cerebrospinal Fluid Shunt Infections
- 82 Prion Diseases
- Part XI The Susceptible Host
- Part XII HIV
- Part XIII Nosocomial Infection
- Part XIV Infections Related to Surgery and Trauma
- Part XV Prevention of Infection
- Part XVI Travel and Recreation
- Part XVII Bioterrorism
- Part XVIII Specific Organisms – Bacteria
- Part XIX Specific Organisms – Spirochetes
- Part XX Specific Organisms – Mycoplasma and Chlamydia
- Part XXI Specific Organisms – Rickettsia, Ehrlichia, and Anaplasma
- Part XXII Specific Organisms – Fungi
- Part XXIII Specific Organisms – Viruses
- Part XXIV Specific Organisms – Parasites
- Part XXV Antimicrobial Therapy – General Considerations
- Index
Summary
Cerebrospinal fluid (CSF) shunts are critical for many patients surviving congenital central nervous system anomalies, infection, or intracranial hemorrhage. Infection is a common complication of these devices and a leading cause of morbidity and hospitalization. Despite this, there is little consensus on the optimal means to prevent and treat these infections.
PATHOGENESIS
Most CSF shunts are silastic tubes inserted into the cerebral ventricles or subarachnoid space and connected to a pressure-regulating valve on the external skull. The proximal shunt is connected to tubing tunneled under the skin to the peritoneal cavity (ventriculoperitoneal shunt). In situations where intraperitoneal drainage is not feasible, the shunt may drain into the right atrium (ventriculoatrial shunt) or pleural cavity (ventriculopleural shunt).
The reported incidence of CSF shunt infections ranges from 1% to 30%, with an average of ≈10% in recent studies. Risk factors for infection include previous surgical revision, a short interval from the time of placement or revision, younger age (particularly premature neonates), a less-experienced surgeon, previous infection, endoscopic surgery, and the presence of a postoperative CSF leak. Shunt valve design does not appear to influence infection rates.
The majority (40% to 75%) of CSF shunt infections are caused by coagulase-negative Staphylococcus spp. Staphylococcus aureus and gram-negative bacilli are each responsible for between 6% and 35% of infections. Escherichia coli, Klebsiella spp., and Pseudomonas aeruginosa are the most commonly reported gram-negative pathogens. Anaerobic bacteria, especially Propionibacterium spp., and fungi are occasionally reported.
- Type
- Chapter
- Information
- Clinical Infectious Disease , pp. 575 - 580Publisher: Cambridge University PressPrint publication year: 2008