Infections in CSF Shunts and External Ventricular Drainage

Abstract

Infection in those with hydrocephalus shunts or external drains (EVDs) can cause serious central nervous system damage with lasting sequelae. The infections usually involve bacterial colonisation and biofilm formation in the catheters. The nature and sources of pathogens and preventive measures are discussed. The risks of infection in shunts and EVDs is different. Infection in shunts is almost always initiated at their insertion or revision (exceptions are described). In contrast, in EVDs, the risk of infection persists throughout their use. The pathogen profile is also different. These factors are important considerations when planning preventive measures. Newer strategies such as antimicrobial catheters are discussed. Diagnosis of EVD infections in an already ill patient is difficult but guidelines can be useful. Treatment of the shunt and EVD infections are also addressed, with reference to modes and routes of antibiotic administration.