Cerebrospinal Fluid Shunt Infection: Emerging Paradigms in Pathogenesis that Affect Prevention and Treatment

Abstract

This medical progress report will outline the epidemiology and healthcare utilization associated with cerebrospinal fluid (CFS) shunt-associated infections in the US, the clinical features of CSF shunt infection, and our evolving understanding of the prevention and treatment of CSF shunt infection. We will describe an emerging paradigm in CSF shunt infection under active investigation. Epidemiology of CSF Shunt InfectionsCSF shunt placement has been the mainstay of treatment for hydrocephalus for over 60 years.(1) CSF shunts allow children with congenital hydrocephalus to survive infancy and allow children with acquired hydrocephalus to avoid further brain injury. Despite their benefits, CSF shunts can cause new and chronic surgical and medical problems. Mechanical malfunction is frequent, and 60% of shunts require surgical revision within 4 years.(2-4) Infection develops in 5% to 15% of all CSF shunts. (5,6)

Antibiotic impregnated and non antibiotic impregnated ventriculoperitoneal shunts in neonatal myelomeningocele associated with hydrocephalus, Is there a valuable difference?

“…Furthermore, treatment of shunt infection is very costly. So, prevention of shunt infection is essential (Simon et al, 2019).…”

Shunt-Bronchial Fistula with Coughing Up and Swallowing of Cerebrospinal Fluid: Rare Complication of Ventriculopleural Shunt

“…Distal shunt infections can manifest in various ways in addition to shunt malfunction: thoracic empyema or pleural effusions/pseudocysts in the setting of ventriculopleural shunts, abdominal pseudocysts or peritonitis with VP shunts, or bacteremia with ventriculoatrial shunts 35, 36, 37, 38. CSF should be sampled, and if possible the fluid collections at the distal site should be aspirated.…”

Treatment strategies for cerebrospinal shunt infections: a systematic review of observational studies

“…Cerebrospinal fluid (CSF) shunt infections impart significant morbidity and occasional mortality in adults and children. 1 Delay in sterilisation of the CSF, relapse (recurrence of infection with the same pathogen as it was not eradicated initially) and reinfection (a new infection, sometimes with a different pathogen) are clearly undesirable outcomes. The Infectious Diseases Society of America (IDSA) guidelines state that the optimal management is removal of the shunt, placement of an external ventricular drain (EVD) and then placement of a new shunt (strong recommendation, moderate quality evidence).…”

“…The Infectious Diseases Society of America (IDSA) guidelines state that the optimal management is removal of the shunt, placement of an external ventricular drain (EVD) and then placement of a new shunt (strong recommendation, moderate quality evidence). 2 However, the optimal choice, duration and route of administration of antibiotics and the optimal timing for replacement of the shunt following CSF sterilisation are not established, 1 2 resulting in significant heterogeneity in management between centres and between neurosurgeons. 3 …”