Infections of Cerebrospinal Fluid Shunts: Epidemiology, Clinical Manifestations, and Therapy

Schoenbaum, Stephen C.; Pierce, Gardner; Shillito, John

doi:10.1093/infdis/131.5.543

Cited by 547 publications

(239 citation statements)

References 38 publications

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“…S. epidermidis is the most common cause of prosthetic hip infections (10), cerebrospinal fluid shunt infections (1,12), and prosthetic valve endocarditis (14,15).…”

mentioning

confidence: 99%

Susceptibility and Synergy Studies of Methicillin-Resistant Staphylococcus epidermidis

Ein

Smith

Aruffo

et al. 1979

Antimicrob Agents Chemother

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Methicillin-resistant Staphylococcus epidermidis is an important cause of cerebrospinal fluid shunt infections and prosthetic valve endocarditis. Agar dilution miniimum inhibitory concentrations were determined for 100 strains of methicillin-resistant S. epidermidis which were isolated from clinical specimens. Vancomycin inhibited all 100 strains at s3.12 pug/ml, whereas clindamycin inhibited only 46 strains at <12.5 pg/mL. Methicillin-resistant S. epidermidis strains were resistant to achievable levels of erythromycin, with 90 strains having a minimum inhibitory concentration of 23.12 pg/ml. Of the five cephalosporins and one cephamycin tested, cefamandole was the most active in vitro, inhibiting 97 strains at S25 pug/ml. Antibiotic synergism was examined by a quantitative bacterial time-kill method. Synergism (.102 kill by the combination over the most effective single antibiotic at 24 h) was demonstrated with vancomycin (1.56 pLg/ml) plus cefamandole (6.25 pLg/ml) in 14 of 14 strains, vancomycin plus cephalothin (6.25 pLg/ml) in 14 of 14 strains, vancomycin plus rifampin (0.008 to 0.012 pg/ml) in 6 of 12 strains, rifampin plus cefamandole in 9 of 12 strains, and rifampin plus cephalothin in 10 of 12 strains. The emergence of populations of bacteria resistant to 0.2 pug of rifampin per ml developed in three offive methicillinresistant S. epidermidis strains tested. The addition of either vancomycin, cephalothin, or cefamandole to the rifampin prevented the emergence of resistance in these three strains. Clinical trials of synergistic antibiotic combination therapy for serious methicillin-resistant S. epidermidis infections are indicated.Staphylococcus epidermidis has been well established as a pathogen in the urinary tract (8), wounds (18), and, most importantly, infections involving indwelling artificial devices. S. epidermidis is the most common cause of prosthetic hip infections (10), cerebrospinal fluid shunt infections (1, 12), and prosthetic valve endocarditis (14, 15).The incidence of methicillin resistance in clinical isolates of S. epidermidis has ranged from 10% (11)

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“…S. epidermidis is the most common cause of prosthetic hip infections (10), cerebrospinal fluid shunt infections (1,12), and prosthetic valve endocarditis (14,15).…”

mentioning

confidence: 99%

Susceptibility and Synergy Studies of Methicillin-Resistant Staphylococcus epidermidis

Ein

Smith

Aruffo

et al. 1979

Antimicrob Agents Chemother

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“…Total shunt revision in our series represented 58.1% of shunt procedures which is much higher than the result of Naftel et Shunt-related infections represent 2 to 27% of total shunt procedures (8,15,18,21,22,28,27,30). Shunt revision due to shunt related infection in our study represented 11.22% of the total cases which is slightly higher than the result of Kulkarni et al (26) who reported 10% infection rate after VPS insertion but less than the results of Kinasha et al (13) who reported 24.6% shunt related infection but overall in our elective neurosurgical procedures the incidence of shunt related infection is still accepted.…”

Section: Discussionmentioning

confidence: 51%

Laparoscopic revision of the distally obstructed ventriculoperitoneal shunt

Abouhashem

Taha²,

Ismail³

et al. 2012

Turkish Neurosurgery

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AIm: Evaluation of the laparoscopic assisted revision of the ventriculoperitoneal shunt as an alternative technique to the traditional laparotomy. mAterIAl and methOds: Out of 1181 elective neurosurgical procedures have been done from January 2009 to December 2010. There are 98 (8.2%) ventriculoperitoneal shunt procedures. New shunt insertion was performed 41 times (41.9%) and shunt revision performed 57 times (58.1%). Shunt-related infection was detected in 11 cases (11.22%) while mechanical failure was found in 46 cases (46.9%), proximal obstruction was diagnosed in 26 cases (26.5 %) while 20 patients (20.4%) suffered from distal obstruction. Out of the 20 patients with distal obstruction, 12 patients were treated with laparoscopic assisted revision of the peritoneal end.results: Intra operative finding revealed peritoneal adhesion in 83.3% of cases and cerebrospinal fluid pseudo cyst in 16.6% while extra peritoneal tube was found in one case. Intraoperative management included adhesiolysis in 10 patient, evacuation and marsupialization of the cyst in two cases in addition to tube repositioning in all cases. There was no procedure-related complications.COnClusIOn: Laparoscopic assisted revision of the peritoneal catheter is an alternative technique to traditional laparotomy in the revision of ventriculoperitoneal shunt.

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“…3,15,35 The clinical consequences of a shunt infection include seizures, psychomotor retardation, reduced intelligence quotient, and increased mortality. 13,22,25,32,37,39 The rate of shunt infection reported varies considerably in the literature, but in recent studies the incidence typically ranges from 5% to 15%, with rates typically higher in high-risk groups such as preterm neonates and patients recently treated for shunt infection. 28,33,34,36,42 Evidence of a shunt infection often manifests within 2 months after surgery.…”

mentioning

confidence: 99%

Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 6: Preoperative antibiotics for shunt surgery in children with hydrocephalus: a systematic review and meta-analysis

Klimo

Poppel

Thompson

et al. 2014

PED

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Object The objective of this systematic review and meta-analysis was twofold: to answer the question “What is the evidence for the effectiveness of prophylactic intravenous antibiotics for infection prevention in shunt surgery?” and to make treatment recommendations based on the available evidence. Methods The US National Library of Medicine PubMed/MEDLINE database and the Cochrane Database of Systematic Reviews were queried using MeSH headings and key words relevant to prophylactic antibiotic use in children undergoing a shunt operation. Abstracts were reviewed to identify which studies met the inclusion criteria. An evidentiary table was assembled summarizing the studies and the quality of evidence (Classes I-III). A meta-analysis was conducted using a random-effects model to calculate a cumulative estimate of treatment effect using risk ratio (RR). Heterogeneity was assessed using chi-square and I2 statistics. A sensitivity analysis was also conducted. Based on the quality of the literature and the result of the meta-analysis, a recommendation was rendered (Level I, II, or III). Results Nine studies (4 Class I, 3 Class II, and 2 Class III) met our inclusion criteria. Of 7 randomized controlled trials (RCTs), 3 were downgraded from Class I to Class II because of significant quality issues, and all RCTs were potentially underpowered. In only 2 Class in retrospective cohort studies were preoperative antibiotic agents found to be protective against shunt infection. When data from the individual studies were pooled together, the infection rate in the prophylactic antibiotics group was 5.9% compared with 10.7% in the control group. Using a random-effects model, the cumulative RR was 0.55 (95% CI 0.38–0.81), indicating a protective benefit of prophylactic preoperative intravenous antibiotics. A sensitivity analysis of RCTs only (n = 7) also demonstrated a statistical benefit, but an analysis of higher-quality RCTs only (n = 4) did not. Conclusions Within the limits of this systematic review and meta-analysis, administration of preoperative antibiotic agents for shunt surgery in children was found to lower the infection risk (quality of evidence: Class II; strength of recommendation, Level II). Recommendation The use of preoperative antibiotic agents can be recommended to prevent shunt infection in patients with hydrocephalus. It was only by combining the results of the various underpowered studies (meta-analysis) that the use of preoperative antibiotics for shunt surgery in children was shown to lower the risk of shunt infection. Strength of Recommendation: Level II, moderate degree of clinical certainty.

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Infections of Cerebrospinal Fluid Shunts: Epidemiology, Clinical Manifestations, and Therapy

Cited by 547 publications

References 38 publications

Susceptibility and Synergy Studies of Methicillin-Resistant Staphylococcus epidermidis

Susceptibility and Synergy Studies of Methicillin-Resistant Staphylococcus epidermidis

Laparoscopic revision of the distally obstructed ventriculoperitoneal shunt

Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 6: Preoperative antibiotics for shunt surgery in children with hydrocephalus: a systematic review and meta-analysis

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