Ventriculoperitoneal shunt infections in children; 10 years of experience in a single center

Abstract

Objective: Shunt infections are a serious health problem seen in children. Our aim in this study is to investigate the clinical features, bacterial pathogens and antimicrobial treatments of pediatric patients with ventriculoperitoneal shunt infection.Methods: This retrospective study included 108 pediatric patients with ventriculoperitoneal shunt infection who were followed up in the Pediatric Infection Clinic of Dicle University Medical Faculty between January 2009 and December 2019. Results:The cases were 48.1% male and 51.9% female. Ventriculoperitoneal were placed in 70.4% of the cases when they were 0-1 months old, and in 15.7% of the cases when they were 2-3 months old. The most common cause of ventriculoperitoneal shunt implantation was congenital hydrocephalus (90.7%), followed by central nervous system tumors (5.6%) and central nervous system infections (2.8%). The most common clinical signs and symptoms were fever (91.7%), vomiting (87%), convulsion (49.1%), change of consciousness (50.9%), meninx irritation finding (37.0%), anterior fontanelle cuff (65.7%), shunt leak (57.4%) and abdominal symptoms (62%). The most frequently isolated pathogens from cerebrospinal fluid cultures were Coagulase negative staphylococcus (36.1%), Staphylococcus aureus (14.8%), Klebsiella pneumoniae (13%), Pseudomonas aeruginosa (6.5%), Acinetobacter baumannii (16%,) and Escherichia coli (11.1%). The most commonly used antibiotics in treatments were vancomycin (68.5%), meropenem (67.5%), ceftriaxone (45.3%), colimycin (26.8%), amikacin (25%), linezolid (21.2%) and cephotaxime (9.2%). The mortality rate of the patients was 20.4%. Conclusions:Knowing the risk factors and taking early precautions in ventriculoperitoneal shunt infections can significantly reduce shunt infections, and better results can be obtained by determining the possible pathogens and starting empirical treatment accordingly.

Healthcare-Associated Ventriculitis in Children during COVID-19 Pandemic: Clinical Characteristics and Outcome of a First Infection

“…As is similar to other series where children under one year represent 35.3% of the cases [10], other authors found that being younger than two years old implies a 2.2 higher risk of developing ventriculitis [14]. In most of the published studies, 80% to 94% of the cases corresponded to children under 5 years [10,14,15]. All the cases in this study were ≤5 years of age.…”

“…Fever was the most frequent clinical manifestation (66.7%), followed by altered mental status. Fever is the most consistent sign in most studies, with percentages ranging from 41.5 to 90% [8,10,15]; other less frequent signs are seizures, diarrhea, vomiting, and abdominal pain. The IDSA guidelines point out that in patients with a ventriculoperitoneal shunt, fever may be the only sign of suspicion to rule out ventriculitis [8].…”

“…The placement of a ventricular shunt is an invasive therapeutic measure necessary to manage hydrocephalus in pediatric patients, mainly in children under 12 months of age (35.3%), which carries a high risk of complications [4,9,10]. HAV is one of the most feared post-surgical complications; rates of infection vary greatly in different centers, from 1% to 45% [4,[8][9][10][11][12][13]. At the beginning of and during the pandemic, HAV rates increased significantly, and the risk for patients was almost four times higher in 2021.…”

“…Moreover, there are no definitions involving ventriculostomies or EVD [7]. The published rate of infections varies greatly (0-45%), and children are at higher risk of infection in comparison to adults [4,[7][8][9][10].…”

“…In middle-and low-income countries, causative bacteria are mostly Gram-positive cocci (Staphylococcus epidermidis and other coagulase-negative species, Staphylococcus aureus, and Enterococcus spp. ), followed by enteric and non-fermenting Gram-negative bacilli (Escherichia coli, Klebsiella pneumoniae, Enterobacter spp., Pseudomonas aeruginosa, and Acinetobacter baumannii) [9,10,[13][14][15].…”