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CSF Shunt Infections: A Fifteen-Year Experience with Emphasis on Management and Outcome

Published online by Cambridge University Press:  18 September 2015

Isabelle Morissette ,
Marie Gourdeau  and
Jacques Francoeur
Isabelle Morissette*
Affiliation:
Clinical Microbiology (I.M., M.G.) and Neurosurgery (J.F.) Services, Hopital de l’Enfant-Jésus, Université Laval, Québec
Marie Gourdeau
Affiliation:
Clinical Microbiology (I.M., M.G.) and Neurosurgery (J.F.) Services, Hopital de l’Enfant-Jésus, Université Laval, Québec
Jacques Francoeur
Affiliation:
Clinical Microbiology (I.M., M.G.) and Neurosurgery (J.F.) Services, Hopital de l’Enfant-Jésus, Université Laval, Québec
*
Laboratoire de Microbiologie, Hôpital de l’Enfant-Jésus, 1401 18e rue, Québec, Quebec, Canada G1J 1Z4
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Abstract:

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A retrospective study of patients with cerebrospinal fluid shunt infections was undertaken from 1975 to 1989 in a university hospital. The data were analyzed with emphasis on the choice of treatment and outcome. There were 44 infectious episodes in 38 patients for an overall rate of 2.6%, including 30 ventriculoperitoneal, 11 ventriculoatrial and 3 lumboperitoneal shunts. The most frequently isolated pathogens were staphylococci in 61% of the cases followed by gram-negative bacilli in 25%. Different modalities of treatment were used: support (2), intravenous antibiotics alone (6), intravenous antibiotics and shunt revision (3), intravenous antibiotics and shunt removal with or without prior externalization of the distal end (33: 13 + 20). The cure rate was 94% (31/33) with this last modality of treatment. Only 3 patients received intraventricular antibiotics. All deaths occurred in patients treated with support only (2) or with antibiotics alone (1). Four of the six recurrent episodes occurred in patients treated with antibiotics alone (2) or with a shunt revision (2). We conclude that carefully chosen intravenous antibiotics combined with shunt removal preceded or not by externalization of the distal end as an alternative therapy to repeated ventricular taps or insertion of an external ventricular drainage device is an appropriate therapy.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 20 , Issue 2 , May 1993 , pp. 118 - 122
Copyright
Copyright © Canadian Neurological Sciences Federation 1993

References

1.Odio, C, McCracken, H, Nelson, JD. CSF shunt infections in pediatrics: a seven year experience. Am J Dis Child 1984; 138: 1103–1108.CrossRefGoogle Scholar
2.Renier, D, Lacombe, J, Pierre-Kahn, A, et al.Factors causing acute shunt infection: computer analysis of 1174 operations. J Neurosurg 1984; 61: 1072–1078.CrossRefGoogle ScholarPubMed
3.Quigley, MR, Reigel, DH, Kortyna, R. Cerebrospinal fluid infections: report of 41 cases and a critical review of the literature. Pediatr Neurosci 1989; 15: 111–120.CrossRefGoogle Scholar
4.Spanu, G, Karussos, G, Adinolfi, D, el al. An analysis of cerebrospinal fluid shunt infections in adults. A clinical experience of twelve years. Acta Neurochirurgica 1986; 80: 79–82.CrossRefGoogle ScholarPubMed
5.Schoenbaum, SC, Gardner, P, Shillito, J.Infections of cerebrospinal fluid shunts: epidemiology, clinical manifestations and therapy. J Infect Dis 1975; 131: 543–552.CrossRefGoogle ScholarPubMed
6.Bisno, Alan L. Infections of central nervous system shunts. In: Bisno, AL, Waldvogel, FA, eds. Infections Associated with Indwelling Medical Devices. Washington: ASM 1989; 93–109.Google Scholar
7.James, HE. Infections associated with cerebrospinal fluid prosthetic devices. In: Sugarman, B. Young, EJ, eds. Infections Associated with Prosthetic Devices. Boca Raton: CRC Press Inc 1984; 23–41.Google Scholar
8.Venes, JL. Infections of CSF shunt and intracranial pressure monitoring devices. In: Grant, O Westenfelder, ed. Infections of Prosthetic Devices. Infectious Disease Clinics of North America. Philadelphia: WB Saunders Co 1989; 3: 289–299.CrossRefGoogle ScholarPubMed
9.McLaurin, RL, Frame, PT. Treatment of infections of cerebrospinal fluid shunts. Rev Infect Dis 1987; 9: 595–603.CrossRefGoogle ScholarPubMed
10.Shapiro, M. Prophylaxis in otolaryngologic surgery and neuro-surgery: a critical review. Rev Infect Dis 1991: 13 (Suppl 10): S858–S868.CrossRefGoogle ScholarPubMed
11.Haines, SJ. Antibiotic prophylaxis in neurosurgery. The controlled trials. Neurosurg Clin N Am 1992; 3 (2): 355–358.CrossRefGoogle ScholarPubMed
12.Walters, BC. Cerebrospinal fluid shunt infection. Neurosurg Clin N Am 1992; 3 (2): 387–401.CrossRefGoogle ScholarPubMed
13.Brook, I, Johnson, N, Overturf, GD, et al.Mixed bacterial meningitis: a complication of ventriculo- and lumboperitoneal shunts; Report of two cases. J Neurosurg 1977; 47: 961–964.CrossRefGoogle Scholar
14.Rekate, HL, Yonas, H, White, RF, et al.The acute abdomen in patients with ventriculoperitoneal shunts. Surg Neurol 1979; II: 442–445.Google Scholar
15.Rush, DS, Walsh, JW, et al.Ventricular sepsis and abdominally related complications in children with cerebrospinal fluid shunts. Surgery 1985; 97:420–427.Google ScholarPubMed
16.Mayhall, CG. Archer, NH. et al.Ventriculostomy-related infections. N Engl J Med 1984; 310: 553–559.Google ScholarPubMed