Shunt infections: a review and analysis of a personal series

Abstract

It is difficult to determine the true incidence of shunt infections as there is no definition of what constitutes a shunt infection. There are no standardized international guidelines as to how to deal with an infected shunt. Though the ability to treat shunt infection has improved and the incidence of shunt infection has decreased over time, there is still no consensus on the best way to manage it. The prevention is predominantly based on common sense and has helped but a more scientific algorithm is the need of the hour.

Ventrikülostomi sonrası gelişen enfeksiyon tanısında prokalsitoninin C-reaktif protein, beyaz küre ve ateşle karşılaştırılması

“…In a study conducted by Pan P. 137 patients included in the study and shunt infection rate was reported as %16.21 13 . Kanangi et al asserted shunt infection to be 3% in their studies 8 . In the current study, we had only one patient (3,7%), among 27 cases, to have shunt-associated infection within one year follow-up period.…”

Evaluation of Ventriculoperitoneal Shunt Infections in Children

“…In the absence of growth in culture, the presence of pleocytosis in CSF (> 10/mm 3 white blood cell), low glucose level (< 45 mg/dL) and high protein level (> 100 mg/ dL) in patients with suspected VPS infection are considered as VPS infection. In a study evaluating pediatric patients with VPS infection, the median values of CSF glucose, protein and cell count were 31 mg/dL (range: 1-269), 159 mg/dL (range, 5-7240) and 100/mm 3 respectively; (range, 0-80.200) (4,11,12). There was no growth in the CSF culture of 17 patients (9).…”

“…The diagnosis is usually based on clinical and laboratory results. Although the frequency of shunt infection varies from centre to centre, it has been reported to be between 2-22% (4,9). In a retrospective study of 442 pediatric patients with eight hundred twenty consecutive VPSs, 92 shunt (11%) infections were reported (10).…”

“…Risk factors for VPS infection are; small age (< 6 months), especially premature birth, cause of hydrocephalus, development of infection at the shunt entrance, recent shunt revision, previous shunt infection, prolonged operation time, surgeon experience, and systemic infection. Shunt infections are observed more frequently in the first two months after shunt insertion and their frequency decreases after one year (4). A history including ew-developed fever, headache and nausea; and physical examination including lethargy, changes in consciousness, redness and tenderness along the shunt path supports VPS infection.…”

“…The most commonly isolated microorganisms in CSF in VPS infections are Staphylococcus epidermidis and Staphylococcus aureus, respectively, which are found in the skin flora and inoculated during shunt surgery. Other factors include Escherichia coli, Klebsiella pneumoniae, Proteus, Pseudomonas, Enterococcus and rarely fungal agents (4,6). The treatment of shunt infections is very difficult and costly.…”