title: Infection of cerebrospinal fluid shunts: causative pathogens, clinical features, and outcomes.
abstract: This retrospective chart review describes the clinical features, pathogens, and outcomes of 46 patients with cerebrospinal fluid (CSF) shunt infections collected over 16 years. The overall CSF shunt infection rate was 2.1%, broken down into 1.7 and 9.3% in adult and pediatric groups, respectively. Fever and progressive consciousness disturbance were the most clinical features in the adult patient group, whereas disturbance of consciousness and abdominal symptoms and signs were the two most common clinical features in the pediatric patient group. The most frequently isolated microorganisms were of the Staphylococcus spp., including Staphylococcus aureus and coagulase negative Staphylococcus, which accounted for 47% of the episodes. Furthermore, increases in polymicrobial and Gram-negative bacilli infections were observed in our study. Due to the high proportion of oxacillin-resistant Staphylococcus spp. and polymicrobial infections, we recommend initial empirical antibiotics with both vancomycin and a third-generation cephalosporin for cases in which the causative bacteria has not been identified or for which the results of antimicrobial susceptibility tests are not available. For patients who develop smoldering fevers, progressive disturbed consciousness, seizures, or abdominal fullness after ventriculoperitoneal shunt procedures, CSF shunt infections should be suspected. Although some infections have been managed successfully with antimicrobial therapy alone, the timely use of appropriate antibiotics according to antimicrobial susceptibility testing and the removal of the shunt apparatus are essential for successful treatment.
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital-Kaohsiung, Taiwan.
authors.forename: Kuo-Wei
authors.initials: KW
authors.lastname: Wang
authors.forename: Wen-Neng
authors.initials: WN
authors.lastname: Chang
authors.forename: Teng-Yuan
authors.initials: TY
authors.lastname: Shih
authors.forename: Chi-Ren
authors.initials: CR
authors.lastname: Huang
authors.forename: Nai-Wen
authors.initials: NW
authors.lastname: Tsai
authors.forename: Chen-Sheng
authors.initials: CS
authors.lastname: Chang
authors.forename: Yao-Chung
authors.initials: YC
authors.lastname: Chuang
authors.forename: Po-Chou
authors.initials: PC
authors.lastname: Liliang
authors.forename: Thung-Ming
authors.initials: TM
authors.lastname: Su
authors.forename: Cheng-Shyuan
authors.initials: CS
authors.lastname: Rau
authors.forename: Yu-Duan
authors.initials: YD
authors.lastname: Tsai
authors.forename: Ben-Chung
authors.initials: BC
authors.lastname: Cheng
authors.forename: Pi-Lien
authors.initials: PL
authors.lastname: Hung
authors.forename: Chin-Jung
authors.initials: CJ
authors.lastname: Chang
authors.forename: Cheng-Hsien
authors.initials: CH
authors.lastname: Lu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001419:Bacteria / Q000302:isolation & purification; D002555:Cerebrospinal Fluid / Q000382:microbiology*; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology*; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D012189:Retrospective Studies; D013210:Staphylococcus / Q000302:isolation & purification; D013530:Surgical Wound Infection / Q000382:microbiology*; D014774:Virulence
chemical_list: D000900:Anti-Bacterial Agents