Cerebrospinal fluid shunt infection: risk factors and long-term follow-up

Vinchon, Matthieu; Dhellemmes, P

doi:10.1007/s00381-005-0037-8

Cited by 189 publications

(148 citation statements)

References 20 publications

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“…This reaffirms that in these groups the suspicion of a shunt infection should be promptly investigated and treated. Gender does not seem to be a risk factor for developing a shunt infection 11,13,16 and there was no difference between the number of males and females infected (55% male, p=0.19) in our study. In our population 68% of infections occurred within nine months of shunt insertion and 59% within three months.…”

Section: Discussioncontrasting

confidence: 63%

“…Overall shunt infection rate in the UK is estimated at 5.2% 7 . Shunt infections have a mortality of 10.1% and worse Glasgow Outcome Scale scores, as well as worse school performance in the long-term 13 . From a public health perspective, shunt infections are associated with major hospital costs, with one episode costing approximately £29,000 14 .…”

Section: Introductionmentioning

confidence: 99%

“…It is recommended to wait until the cultures have been sterile for at least 72 hours before implanting a new shunt 5 . There is some evidence that in case of low-grade inflammation the patient can sometimes be treated with antibiotics alone, but success rates are reported to be low 3,4,13,14 .…”

Section: Introductionmentioning

confidence: 99%

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Characteristics and management of ventricular shunt infections in children, 2000-2015: a single centre retrospective chart review

et al. 2018

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Infections are a common and serious complication of ventricular Background: shunts that can lead to significant mortality and morbidity. Treatment consists of surgical and antimicrobial therapy, but there is a lack of evidence regarding optimal management. We therefore aimed to analyse the current practice and patient outcomes within a large tertiary referral centre.We identified cases of infection in ventriculoperitoneal shunts from Methods: January 2000 until April 2015 in our institution. All patients were under 18 years at the time of infection. Clinical, microbiological and radiological data were collected with the use of a standardised proforma. Non-parametric tests were used for statistical analysis.There were 92 episodes of infection in 65 patients. The most common Results: microorganisms were coagulase-negative staphylococci (47%), followed by (16%). Surgical treatment included shunt Staphylococcus aureus externalisation (15%) and complete removal (67%). Antibiotics were given in 97% of the patients in addition to surgery. Vancomycin, linezolid, cefotaxime, meropenem and rifampicin were used most frequently. The median duration of antibiotic treatment was 18 days (IQR 14-25 days). Two patients died from consequences of a shunt infection and seven had recurrent infection.It would be beneficial to develop a guideline for recognition and Conclusions: treatment of shunt infections. Complete removal of the shunt and placement of an EVD seems the safest surgical treatment. Empirical antibiotic treatment should be started as soon as possible. A combination of linezolid and ceftriaxone would be appropriate first line antibiotics, with meropenem as second line. Antibiotics can be rationalised once the CSF culture results are known.

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Section: Discussioncontrasting

confidence: 63%

Section: Introductionmentioning

confidence: 99%

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Characteristics and management of ventricular shunt infections in children, 2000-2015: a single centre retrospective chart review

et al. 2018

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“…Factors including premature birth, occurrence of the first VPSI at a young age, congenital conditions such as meningomyelocele, post-hemorrhagic hydrocephalus, higher number of previous shunt infections, and the development of postoperative CSF leakage increase the risk of shunt infection (4,6,7,18,25). In this study, we found that children with VPSI in the first 3 months or with premature birth had a greater rate of shunt infections (high hospitalization coefficient) and higher treatment costs (high cost coefficient).…”

Section: Kanik a Et Al: Aspects Of Vps-related Infectionsmentioning

confidence: 56%

Clinic and economic results of the ventriculoperitoneal shunt infections in children

Kanık¹,

Sirin²,

Köse³

et al. 2014

Turkish Neurosurgery

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AIm: This study evaluated the clinical and economic outcomes of ventriculoperitoneal shunt infections. mATErIAl and mEThOds:Patients diagnosed with ventriculoperitoneal shunt infections for the first time between 1 January 2007 and 31 December 2011 were included in this study. Demographic, clinical, and economic data were analyzed retrospectively. A cost coefficient (total cost/follow-up period) and hospitalization coefficient (duration of hospitalization/follow-up period) were calculated for each patient. rEsulTs:In total, 132 shunt infections (mean follow-up, 734 ± 367 days) were evaluated in 51 patients (mean age, 16.6 ± 9.22 months; median age, 3 months; range, 1-88 months; 28 females, 21 males). In 23 patients (45%), shunt infections were seen in the first 2 months following shunt placement. Seven patients died during the follow-up. There was a negative correlation between the age at diagnosis and the hospitalization duration (p = 0.005, r = -0.381). The average cost of hospitalization per patient was 6397 ± 4338 TL. There was a negative correlation between the cost index and the age at diagnosis (p = 0.04, r = -0.292).CONClusION: Ventriculoperitoneal shunt infections have significant medical and economic impacts. Younger the diagnosis of patients, the hospitalization duration and treatment cost were higher. BulGulAr: Toplam 51 olgudaki (ortalama yaş: 2,58±1,75 ay; ortanca yaş: 3 ay: dağılım aralığı: 1-88 ay; 28 kız / 21 erkek) 132 şant enfeksiyonu (ortalama izlem süresi: 734± 367 gün) değerlendirilmeye alındı. Olguların 23'ünde (%45) ilk enfeksiyon şantın takılmasından sonraki ilk 2 ayda ortaya çıktı. Toplam yedi hasta izlemde kaybedildi. Olguların tanı yaşları ile yatış süresi katsayıları arasında negatif yönde anlamlı bir korelasyon olduğu görüldü (p=0,005; r = -0,381). Bir hasta için yatış başına düşen ortalama maliyet 6397±4338 TL olarak hesaplandı. Bu hastaların maliyet katsayısı ile tanı yaşı arasında negatif yönde anlamlı bir korelasyon saptandı (p=0,04; r = -0,292). sONuÇ: Ventriküloperitoneal şant enfeksiyonları ciddi tıbbi ve ekonomik sonuçlara neden olmaktadır. Hastaların tanı yaşı küçüldükçe hastanede yatış süreleri ve tedavi maliyetleri artmaktadır.

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“…Although IV antibiotics are a mainstay of clinical practice in conjunction with surgery [13,24,25], duration of IV antibiotic use varies widely [14] and depends, in part, on the surgical approach used [1,26] and pathogen involved [25,27]. In previous studies, observed durations range from 9 days to 17 days [14,15,17].…”

Section: Discussionmentioning

confidence: 99%

Few Patient, Treatment, and Diagnostic or Microbiological Factors, Except Complications and Intermittent Negative Cerebrospinal Fluid (CSF) Cultures During First CSF Shunt Infection, Are Associated With Reinfection

Simon¹,

Mayer-Hamblett²,

Whitlock³

et al. 2013

Journal of the Pediatric Infectious Diseases Society

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Background. The relationship between first and subsequent cerebrospinal fluid (CSF) shunt infections is poorly understood. By understanding the factors associated with increased risk of reinfection, researchers may provide optimal treatment strategies at the time of first infection. The objective of this study was to describe and compare children with and without CSF shunt reinfection. Methods. A retrospective cohort study was performed among 118 children who underwent initial CSF shunt placement and developed first CSF shunt infection. The primary outcome variable was CSF shunt reinfection. Patient risk factors and medical and surgical management of initial CSF shunt placement and first CSF shunt infection were compared between children with and without reinfection. Results. Of 118 children with first infection, 31 (26%) developed a reinfection during the study period (overall median follow-up, 2096 days). Factors associated with reinfection in this cohort included ventriculoatrial or complex shunt at initial CSF shunt placement, complications after first CSF shunt infection, and intermittent negative CSF cultures. Conclusions. Few patient or treatment factors were associated with reinfection. Factors associated with difficult-to-treat first CSF shunt infection, including complications after first CSF shunt infection and intermittent negative CSF cultures, were associated with reinfection. Clinicians who treat patients with unusual CSF shunts or more difficult first infections should have a high index of suspicion for reinfection after treatment is completed.

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Cerebrospinal fluid shunt infection: risk factors and long-term follow-up

Abstract: Long-term follow-up of shunted children is necessary to evaluate the real incidence of SI and the functional outcome after SI.

Cited by 189 publications

References 20 publications

Characteristics and management of ventricular shunt infections in children, 2000-2015: a single centre retrospective chart review

Characteristics and management of ventricular shunt infections in children, 2000-2015: a single centre retrospective chart review

Clinic and economic results of the ventriculoperitoneal shunt infections in children

Few Patient, Treatment, and Diagnostic or Microbiological Factors, Except Complications and Intermittent Negative Cerebrospinal Fluid (CSF) Cultures During First CSF Shunt Infection, Are Associated With Reinfection

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