title: Repeat cerebrospinal fluid shunt infection in children.
abstract: BACKGROUND
  In this study, we investigated the treatment of cerebrospinal fluid (CSF) shunt infection and the risk factors for repeat shunt infection (RSI) in a cohort of children treated at the Hospital for Sick Children, Toronto, Canada.
  
  
  METHODS
  Between 1996 and 2000, a total of 51 children were identified with shunt infection (mean age 5.8 years). The medical records of these children were reviewed to identify cases of RSI within 6 months of the initial shunt infection (ISI).
  
  
  RESULTS
  In the 51 ISIs, the infecting organisms were coagulase-negative Staphylococcus (43.1%), Staphylococcus aureus (37.3%) and others (19.6%). The initial mode of treatment of the shunt infection was using an external ventricular drain (EVD) with removal of the shunt apparatus (54.9%), externalization of the shunt (37.3%) or shunt removal only (7.8%). The mean number of days of external CSF drainage (either EVD or externalized shunt) was 11.2 days. Ten patients (19.6%) developed RSI. The actuarial risk of RSI plateaued after 90 days at 24.4%. The following variables were tested as risk factors for RSI using survival analysis, although none reached statistical significance: initial organism (p = 0.09), age (p = 0.42), etiology of hydrocephalus (p = 0.45), number of days of CSF drainage (p = 0.45), type of surgical treatment of the ISI (p = 0.58) and the presence of bacteriologically positive CSF at ISI (p = 0.85).
  
  
  CONCLUSIONS
  The risk of RSI is substantial and greater effort needs to be directed towards understanding the risk factors. Such studies will need a greater sample size in order to obtain sufficient statistical power.
authors.affiliation: Division of Neurosurgery, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
authors.forename: A V
authors.initials: AV
authors.lastname: Kulkarni
authors.forename: D
authors.initials: D
authors.lastname: Rabin
authors.forename: M
authors.initials: M
authors.lastname: Lamberti-Pasculli
authors.forename: J M
authors.initials: JM
authors.lastname: Drake
mesh_terms: D000293:Adolescent; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D016459:Prosthesis-Related Infections / Q000209:etiology* / Q000401:mortality; D012307:Risk Factors; D016019:Survival Analysis