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

Abstract

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%.

Few Patient, Treatment, and Diagnostic or Microbiological Factors, Except Complications and Intermittent Negative Cerebrospinal Fluid (CSF) Cultures During First CSF Shunt Infection, Are Associated With Reinfection

“…Further study is needed to determine the optimal duration and spectrum of therapy. Surgical management of CSF shunt infection includes primarily shunt removal and EVD insertion followed by new shunt placement once the CSF is sterile, and less frequently shunt externalization followed by shunt replacement [13,17,[28][29][30][31][32]. Surgical management is also of considerable interest and substantial variation [14,16,17,22], with shunt removal or new shunt placement ranging from 55% to 71% and externalization ranging from 12% to 37% [14,15,17].…”

2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis*

“…The case incidence of CSF shunt infection (ie, the occurrence of infection in any given patient) has ranged from 5% to 41% in various series, although the incidence is usually in the range of 4%-17% [7][8][9][10][11][12][13][14]. The operative incidence (ie, the occurrence of infection per procedure) has ranged from 2.8% to 14%, although most series have generally reported operative infection rates of less than 4% [15][16][17]. Factors associated with an increased risk of CSF shunt infection include premature birth (especially when associated with intraventricular hemorrhage), younger age, previous shunt infection, cause of hydrocephalus (more likely after purulent meningitis, hemorrhage, and myelomeningocele), less experienced neurosurgeon, higher number of people traversing the operating theater, exposure to perforated surgical gloves, intraoperative use of the neuroendoscope, longer duration of the shunt procedure, insertion of the catheter below the level of the T7 vertebral body in those with ventriculoatrial shunting, improper patient skin preparation, shaving of skin, exposure of large areas of the patient's skin during the procedure, and shunt revision (risk is especially high in those undergoing 3 or more revisions) [18,19].…”

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

“…Clinical symptoms are often nonspecific, especially when shunt-associated infections are caused by lowvirulence organisms, such as coagulase-negative staphylococci or Propionibacterium acnes [11]. Often, only signs of intracranial hypertension attributable to shunt malfunction are present, such as headache, nausea, vomiting, and/or change in mental state [12][13][14][15]. It is crucial to diagnose shunt-associated infection early and accurately to be able to plan an appropriate medical and/or surgical intervention.…”