Antimicrobial treatment options for neurosurgical ventricular shunt infections in children from 1993 to 2012: a systematic review

Abstract

This systematic review has shown that there are no prospective randomised studies of antimicrobial treatment options for paediatric neurosurgical patients in the last 20 years, and larger prospective studies are urgently required for this serious infection. There is some limited case series showing the benefits of certain antimicrobials such as vancomycin and ceftriaxone, but a larger case series or randomised controlled trial is required, particularly to establish the benefit, if any, of additional intraventricular antimicrobials.

Characteristics and management of ventricular shunt infections in children, 2000-2015: a single centre retrospective chart review

“…In this study, fever was the most common symptom (67% of the episodes), with cutaneous S. epidermidis, S. aureus and other CoNS were the most frequently observed and together accounted for 54% of the organisms found. This correlated with findings from other groups from the United Kingdom, the United States of America, Taiwan, Korea, Spain and Germany 7,[9][10][11][12]14,[17][18][19][20] . Another relatively frequent organism in the literature was Propionibacterium acnes 19,26,27 which was not identified in our cohort possibly due to the fact this organism is mainly found in patients over the age of 14-15 years old, whereas 88% (n=80) of the episodes in this study occurred before 14 years.…”

“…In CSF infections, it is best practice to remove the infected device completely and insert an EVD until the CSF is sterilised 18,20 . However, in infections very soon after insertion of a shunt, treatment with antibiotic alone could be justified, as the microorganisms have not had the time yet to form a biofilm, but there is a paucity of evidence for this at present and currently the safest option is to remove the infected device completely.…”

“…Other common organisms are Staphylococcus aureus (5-26%) and other CoNS (36.1-53%) [9][10][11]17,19 . Gram-negative organisms are also frequent findings, accounting for up to 54% of infections in some series 20 . Gram-negative rods were identified in approximately 7-9% of infections 11,17 .…”

“…Gram-negative rods were identified in approximately 7-9% of infections 11,17 . Treatment of shunt infection requires complete removal of the device in combination with temporary drainage, unless infection is confined to the abdomen in which case there is a period of shunt externalisation before replacement 18,20 . Early surgical intervention is especially important since staphylococci commonly form a biofilm after colonising an implant, making it more difficult for antibiotics to penetrate and eradicate infection 21 .…”

Infections of Intrathecal Baclofen Delivery Systems and Ventriculoperitoneal Shunting Systems: Clinical Series Discussion

“…Modern invasive treatment modalities have altered the management and improved the prognosis for many patients over the recent years [1,2] . Intrathecal baclofen (ITB) therapy has been established as an effective treatment of spinal as well as cerebral spasticity [2][3][4][5][6][7] .…”