Characteristics and Treatment Outcome of Cerebrospinal Fluid Shunt–Associated Infections in Adults: A Retrospective Analysis over an 11‐Year Period

Conen, Anna; Walti, Laura N; Merlo, Adrian; Flückiger, Ursula; Battegay, Manuel; Trampuž, Andrej

doi:10.1086/588298

Cited by 228 publications

(216 citation statements)

References 32 publications

Supporting

Mentioning

182

Contrasting

Unclassified

Order By: Relevance

“…acnes, classically considered to be a low-virulence organism, has been implicated in a number of PCNSIs, including bone-flapassociated infection, ventriculoperitoneal shunt infection, Ommaya reservoir infection, nosocomial meningitis after craniotomy, and subdural, extradural, and cerebral abscesses (7)(8)(9)(10)(11)(12). Without a prior neurosurgical procedure, meningitis due to P. acnes is exceedingly rare, with only eight prior case reports identified in the English language literature.…”

Section: Case Reportmentioning

confidence: 99%

“…In a study looking at postsurgical meningitis, overall 79% of cases had fever and 31% had neurologic symptoms, although only 15% of the cases were caused by P. acnes (19). A study of ventricular shunt infections in which 9% of cases were caused by P. acnes found that overall 36% of patients presented without neurologic signs or symptoms and 78% had fever (7). Unfortunately, these studies do not delineate clinical characteristics of specific postsurgical pathogens; therefore, direct comparison is somewhat limited.…”

Section: Case Reportmentioning

confidence: 99%

See 1 more Smart Citation

De Novo Meningitis Caused by Propionibacterium acnes in a Patient with Metastatic Melanoma

et al. 2014

View full text Add to dashboard Cite

Propionibacterium acnes is a known cause of postneurosurgical meningitis; however, it is rarely implicated in de novo meningitis. Herein we report a case of a 49-year-old male with de novo meningitis caused by P. acnes with metastatic melanoma as the only identified risk factor for his infection. CASE REPORTA 49-year-old Caucasian male presented to his primary care physician with an 11-week history of bifrontal headaches associated with nausea and emesis but without other symptoms of meningismus. Symptomatic relief was provided with over-thecounter pain medications and antiemetics. Five weeks prior to arrival at our institution, the patient was admitted to an outside hospital for intractable vomiting and headaches. A computed tomography (CT) scan of the head and abdomen were performed, both of which were normal. Two weeks prior to admission, his headache and nausea worsened with the onset of subjective fevers, low back pain, lethargy, and confusion.Roughly 2 years prior to admission, the patient was diagnosed with stage IIIC melanoma of the right lower extremity, for which he underwent resection and lymphadenectomy. In the intervening period, he was thought to be in remission. Eight weeks prior to admission, a left-lower-extremity skin biopsy specimen demonstrated a melanocytic nevus.At the time of admission, his vital signs were as follows: temperature, 36.7°C; blood pressure, 168/92 mm Hg; heart rate, 87 beats per minute; respiratory rate, 20 breaths per minute; oxygen saturation of 98% on room air; height, 188 cm (74 in.); and weight, 142 kg (312.4 lb). The physical exam showed a well-developed male in no acute distress, alert, and oriented to place, year, self, and situation. Notable findings included right-lower-extremity swelling, a healed scar at the site of his prior melanoma, and ecchymosis surrounding a left-lower-extremity biopsy site. He did not have signs of meningismus.Laboratory findings on admission included a hemoglobin level of 14.1 g/dl, hematocrit of 40.3%, white blood cell count of 10,300/mm 3 , mildly elevated absolute neutrophil count of 7,600/ mm 3 (range, 1,800 to 6,600/mm 3 ), normal chemistry panel, an alanine transaminase level of 89 U/liter (range, 7 to 53 U/liter) but otherwise normal hepatic function panel, and a normal urinalysis.A repeat CT scan of the head was obtained on hospital day 2, 5 weeks after the prior scan, which revealed a communicating hydrocephalus. CT myelography was also performed on day 2, which showed clumping of the nerve roots within the lumbar spine and nodular thickening surrounding L2-L3 nerve roots consistent with arachnoiditis versus metastatic disease.A fluoroscopically guided lumbar puncture (LP) was performed on hospital day 2, which yielded clear, yellow cerebrospinal fluid (CSF) with a glucose concentration of 26 mg/dl (serum glucose, 96 mg/dl), protein concentration of 518 mg/dl, 145 nucleated cells/l (1% neutrophils, 32% macrophages, 10% monocytes, 6% lymphocytes, and 51% unclassified cells due to poor cell viability), 576 red blood cells/l, and an...

show abstract

Section: Case Reportmentioning

confidence: 99%

Section: Case Reportmentioning

confidence: 99%

De Novo Meningitis Caused by Propionibacterium acnes in a Patient with Metastatic Melanoma

et al. 2014

View full text Add to dashboard Cite

show abstract

“…2 The rate of shunt-associated infections ranges from 1% to 18%, and such infections are associated with high morbidity and mortality. 3 Assessment of the optimal functioning of a CSF shunt is subject to variation, and once a CSF shunt is inserted, it almost always remains for the life of the patient. However, CSF shunt independence (ie, a shunt that is no longer necessary), although uncommon, is not exceptional.…”

Section: When An Infection Prompts Removal Of An Unnecessary Devicementioning

confidence: 99%

“…2 After the reminder, patients were prospectively followed on days 2 and 7 for catheter removal, development of CAUTI, and indications for not removing an unnecessary urinary catheter. In this hospital, interns, resi- 3 Factors associated with not removing urinary catheters were computed using multivariable analysis. During the 1-month study period, 39 patients had urinary catheter placement, 22 (56%) of whom received inappropriate urinary catheterization (Table 1).…”

Section: Factors Associated With Not Removing Urinary Catheter After mentioning

confidence: 99%

When an Infection Prompts Removal of an Unnecessary Device

Petrosillo

Bella

Taglietti

2012

Infect. Control Hosp. Epidemiol.

View full text Add to dashboard Cite

“…For the purposes of this review, we will focus on the clinical presentation, diagnosis, and management of acute bacterial meningitis, encephalitis, bacterial empyema, and brain abscess. Other important causes of acute CNS infections, such as postneurosurgical or posttraumatic meningitis are beyond the scope of this review and are covered elsewhere [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

Neuro-Intensive Care of Patients with Acute CNS Infections

Beckham

Tyler

2012

Neurotherapeutics

View full text Add to dashboard Cite

Summary Infections in the central nervous system (CNS) are caused by a wide range of microorganisms resulting in distinct clinical syndromes including meningitis, encephalitis, and pyogenic infections, such as empyema and brain abscess. Bacterial and viral infections in the CNS can be rapidly fatal and can result in severe disability in survivors. Appropriate identification and acute management of these infections often occurs in a critical care setting and is vital to improving outcomes in this group of patients. This review of diagnosis and management of acute bacterial and viral infections in the CNS provides a general approach to patients with a suspected CNS infection and also provides a more detailed review of the diagnosis and management of patients with suspected bacterial meningitis, viral encephalitis, brain abscess, and subdural empyema.

show abstract

Characteristics and Treatment Outcome of Cerebrospinal Fluid Shunt–Associated Infections in Adults: A Retrospective Analysis over an 11‐Year Period

Abstract: Shunt-associated infections among adults often present with nonspecific clinical signs, and affected patients can have normal CSF leukocyte counts and lactate levels; therefore, a high index of suspicion and improved methods are required for diagnosing shunt-associated infection.

Cited by 228 publications

References 32 publications

De Novo Meningitis Caused by Propionibacterium acnes in a Patient with Metastatic Melanoma

De Novo Meningitis Caused by Propionibacterium acnes in a Patient with Metastatic Melanoma

When an Infection Prompts Removal of an Unnecessary Device

Neuro-Intensive Care of Patients with Acute CNS Infections

Contact Info

Product

Resources

About