A retrospective study of central nervous system shunt infections diagnosed in a university hospital during a 4-year period

Saçar, Suzan; Turgut, Hüseyin; Toprak, Semra; Çırak, Bayram; Çoşkun, Erdal; Yılmaz, Özlem; Tekin, Koray

doi:10.1186/1471-2334-6-43

Cited by 63 publications

(48 citation statements)

References 10 publications

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“…A. baumannii identifi cation without cerebrospinal fl uid alterations was considered contamination/colonization. 1 Variables abstracted from the patient record, summarized in Table 1 and 2, were: gender, age, cerebrospinal fl uid (number of leukocytes/mm 3 , glucose, and protein levels), history of trauma, presence of external shunt at the time of meningitis diagnosis, days of admission before infection and total length of hospital stay, elective surgery, previous use of antibiotics, susceptibility tests for Acinetobacter, antibiotic therapy (intravenous and intrathecal) used, and patient outcome. Acinetobacter baumannii was identified using biochemical methods.…”

Section: Methodsmentioning

confidence: 99%

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Mortality rate in patients with nosocomial Acinetobacter meningitis from a Brazilian hospital

Tuon¹,

Penteado-Filho²,

Amarante³

et al. 2010

Braz J Infect Dis

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Background:The mortality rate due to Acinetobacter baumannii nosocomial meningitis (ANM) is high. Objective: The aim of this study was to evaluate the factors that have infl uence over the outcomes in ANM patients. Methods: A retrospective analysis of 22 cases of ANM was conducted in a hospital with high incidence of multidrug resistance. Results: The mean age of patients was 43 years (21 to 91) and 54.5% were male. All ANM cases occurred within 60 days of admission and the mean duration of illness was of 18.2 days. All cases were associated with previous neurosurgical procedures: elective surgery (27.2%), external shunt (54.4%) and emergency surgery due to trauma (18.1%). Imipenem resistance was observed in 40.9% of cases, but ampicillin/sulbactam resistance was lower (27.2%). The mortality rate of ANM patients was of 72.7%. The only risk factor associated with mortality was inappropriate therapy within fi ve days after CSF collection. All patients who survived the meningitis episode had received appropriate therapy, in contrast to only 69.2% of those who did not survive (OR = 5.15; IC = 0.45-54.01). Conclusions: The high mortality rate observed in our study suggests the need for aggressive empirical treatment with addition of drugs, including intrathecal therapy, where multi-resistant A. baumannii is endemic.

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Section: Methodsmentioning

confidence: 99%

“…Currently, Acinetobacter is the second most common agent of nosocomial meningitis in some hospitals. 1 The mortality rate is high and those who outlive the infectious episode usually have severe neurological defi cits. 2 The estimated 15% mortality rate of nosocomial meningitis 3 increases to 40% if caused by Acinetobacter.…”

Section: Introductionmentioning

confidence: 99%

Mortality rate in patients with nosocomial Acinetobacter meningitis from a Brazilian hospital

Tuon¹,

Penteado-Filho²,

Amarante³

et al. 2010

Braz J Infect Dis

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“…(10), among the most dreaded strains that can cause postoperative meningitis (12), especially the biofilm-producing strains (11).…”

Section: Penetration Of Intact Blood-brain Barrier By Doripenemmentioning

confidence: 99%

Penetration of Intact Blood-Brain Barrier by Doripenem

Margetis

Dimaraki²,

Charkoftaki

et al. 2011

Antimicrob Agents Chemother

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“…Sonuçları itibari ile oldukça yüksek morbidite ve mortaliteye sahip olabilen bu tablonun erken ve uygun tedavisi, kritik öneme sahiptir. Bu amaçla başvurulan medikal ve cerrahi tedaviler arasında en yaygın kullanılan yöntem şant uygulamasıdır (1,2). Bu uygulamada amaç, aşırı biriken BOS'u dışarı veya vücut boşluklarından birine boşaltarak kafa içinde oluşan basıncı ve buna bağlı gelişebilecek yaşamsal riskleri azaltmaktır.…”

unclassified

Cerebrospinal Fluid Shunt Infections

Öncü¹

2010

Klimik Dergisi

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ÖzetHidrosefali tedavisinde kullanılan medikal ve cerrahi tedaviler arasında şant, uygulaması en çok tercih edilendir. Beyin-omurilik sıvısı (BOS), şant ile vücut dışına ya da seröz boşluklardan birine yönlendirilerek kafaiçi basıncının azaltılması sağlanmaktadır. Bu cihazların kullanımı sırasında ortaya çıkabilecek komplikasyonlardan biri şantın infeksiyonudur. Ortalama %5-15 sıklığında saptanan şant infeksiyonlarına neden olan etkenler çoğunlukla deri normal fl orasından kaynaklanmaktadır. Cerrahi işlem sıra-sında veya yara iyileşmesi sürecinde mikroorganizmaların şanta bulaşması infeksiyon gelişmesinde en bilinen yoldur. Hastada saptanan klinik belirtiler kullanılan şant tipine göre farklılıklar gösterebilmektedir. Ventrikülo-peritoneal (VP) şant infeksiyonunda karın ağrısı ön planda iken, ventrikülo-atriyal (VA) şant infeksiyonunda ateş en belirgin belirtidir. Şant infeksiyonu düşü-nülen hastalarda BOS'un hücresel, biyokimyasal ve mikrobiyolojik analizleri yapılmalıdır. İnfeksiyon tanısı konulan hastalarda antibiyotik tedavisi ile birlikte şantın revizyonu altın standard yaklaşımdır. Sistemik antibiyotik tedavisi yanında indikasyonu olan vakalarda intraventriküler antibiyotik uygulanması söz konusudur. Şant infeksiyonlarından korunmanın en etkili yolu, cerrahi alan infeksiyonlarını önlemek için gerekli prensiplere maksimum düzeyde uyulmasıdır. Klimik Dergisi 2010; 23(3): 77-82.Anahtar Sözcükler: Beyin-omurilik sıvısı şantları, infeksiyon. AbstractShunt is the most common approach among medical and surgical treatment modalities for treating hydrocephalus. The main purpose of the shunt is to reduce intracranial pressure by draining the cerebrospinal fl uid (CSF) from the ventricles. Infection is one of the serious complications and it develops in approximately 5-15% of the inserted devices. The microorganisms responsible for the shunt infection usually arise from the normal fl ora of the skin. During the surgical procedure and healing period, microorganisms residing in skin may adhere to the shunt and start the infection. The clinical symptoms may differ according to the type of shunt used. Abdominal pain is the most common complaint in patients with infected ventriculo-peritoneal (VP) shunt. On the other hand, fever is the leading symptom in ventriculo-atrial (VA) shunt infection. Other than clinical signs, biochemical and microbiological analysis of CSF are necessary to diagnose shunt infection. The gold standard of treatment is the usage of antibiotics with shunt revision. In addition to parenteral antibiotics, intraventricular administration of antibiotics may be an essential part of the treatment. The most effi cient way to avoid shunt infection is to follow the strict rules for preventing surgical site infections.

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A retrospective study of central nervous system shunt infections diagnosed in a university hospital during a 4-year period

Cited by 63 publications

References 10 publications

Mortality rate in patients with nosocomial Acinetobacter meningitis from a Brazilian hospital

Mortality rate in patients with nosocomial Acinetobacter meningitis from a Brazilian hospital

Penetration of Intact Blood-Brain Barrier by Doripenem

Cerebrospinal Fluid Shunt Infections

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