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

Abstract

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.