Evaluation of Risk Factors for Recurrent Ventriculoperitoneal Shunt Infections in Adult

Abstract

Objective: The objective of this paper is to evaluate demographic, clinical, laboratory and microbiological features of ventriculoperitoneal shunt (VPS) infections in this 13 year retrospective study. VPS-related bacterial agents and their antibiotic sensitivity were also investigated in single VPS (SVPS) and recurrent VPS (RVPS) infections. Methods: The study included 110 patients with SVPS infection and 55 patients with RVPS infection. Results: In patients who developed multiple infections, gram-negative organisms were the most predominant (60%, 54/90). Resistance rates were 85.2% for third generation cephalosporins, 83.3% for Piperacillin-Tazobactam, and 10.4% for Carbapenem's. Forty-nine % of patients in the SVPS and 84.4% in the RVPS infection group were treated with combinations of carbapeneme. Central nervous system (CNS) tuberculosis as the etiology of hydrocephalus, short duration of antibiotics used for treatment, high cerebrospinal fluid (CSF) protein and blood C-reactive protein (CRP) levels, and prolonged use of prophylactic antibiotics was found related to increased rate of recurrent infection occurrence. Two-stage shunt change decreased the risk of recurrent infections. Conclusions: VPS infection may be life-threating and its management rucial. Rational and appropriate use of antibiotics and treatment methods according to the algorithms can reduce recurrent infections. Gram-negative predominant bacterial colonization and its carbapenem sensitivity in RVPS infection has to be kept in mind to manage the infection effectively.