Duration of Antibiotic Therapy and Timing of Shunt Reimplantation in Pediatric CSF Shunt Infections: A Retrospective Multicenter Case Series

Robinson, Joan; McAlpine, Alastair; Barton, Michelle; Balamohan, Archana; Davies, H. Dele; Skar, Gwenn; Lefebvre, Marie-Astrid; Almadani, Ahmed; Freire, Dolores; Saux, Nicole Le; Bowes, Jennifer; Srigley, Jocelyn A.; Passarelli, Patrick; Bradley, John S.; Khan, Shahed U. M.; Purewal, Rupeena; Viel-Thériault, Isabelle; Hawkes, Michael

doi:10.1093/jpids/piac037

Cited by 1 publication

(4 citation statements)

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“…Complication rates are high, with one multicentre study reporting 40% of patients had at least one complication resulting from shunt infection 25. Complications in this study included contiguous soft tissue infection, worsening hydrocephalus, CSF leak, intracranial haemorrhage, brain abscess and venous thrombosis 25.…”

Section: Discussionmentioning

confidence: 82%

“…Complications in this study included contiguous soft tissue infection, worsening hydrocephalus, CSF leak, intracranial haemorrhage, brain abscess and venous thrombosis 25. Rates of recurrence are 11%–16% 7 25 27. Patients may also acquire a secondary infection, such as an infected external ventricular drain.…”

Section: Discussionmentioning

confidence: 94%

“…Infection may result in shunt malfunction or scarring of the ventricles, leading to worsening hydrocephalus 33. Other complications include soft tissue infection, CSF leak, intracranial bleed, brain abscess and venous thrombosis 25. Shunt nephritis may result in patients with ventriculoatrial shunts, when chronic bacteraemia causes formation of antigen–antibody complexes that deposit in the kidney 2…”

Section: Discussionmentioning

confidence: 99%

“…Recommended duration is primarily based on expert opinion, as there are no controlled trials to indicate the optimal therapy duration. Recent multicentre studies report that most children receive antimicrobial therapy for longer than recommended 25 26. Prolonged use of antibiotics is associated with increased healthcare costs and risks to the patient such as Clostridium difficile colitis and selection of resistant pathogens.…”

Section: Managementmentioning

confidence: 99%

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Cerebrospinal fluid shunt infections in children

2022

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Cerebrospinal fluid (CSF) shunts are commonly used for the long-term management of hydrocephalus in children. Shunt infection remains a common complication, occurring in about 5%–15% of CSF shunts. This narrative review summarises key evidence from recent literature on the epidemiology, pathogenesis, clinical presentation, diagnosis, management, outcomes and prevention of CSF shunt infections in children. The majority of shunt infections occur due to contamination at the time of surgery, with coagulase-negative staphylococci andStaphylococcus aureusbeing the most common infecting organisms. Clinical presentations of shunt infection can be varied and difficult to recognise. CSF cultures are the primary test used for diagnosis. Other CSF and blood parameters may aid in diagnosis but lack sensitivity and specificity. Core aspects of management of shunt infections include systemic antimicrobial therapy and surgical removal of the shunt. However, many specific treatment recommendations are limited by a lack of robust evidence from large studies or controlled trials. Shunt infections may result in long hospital stays, worsening hydrocephalus, neurological sequelae and other complications, as well as death. Therefore, reducing the incidence of infection and optimising management are high priorities. Antibiotic prophylaxis at the time of shunt placement, improved surgical protocols and antibiotic-impregnated shunts are key strategies to prevent shunt infections. Nevertheless, further work is needed to identify additional strategies to prevent complications and improve outcomes.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 94%