Management of shunt infections: a multicenter pilot study.
OBJECTIVE
Approximately 10% of cerebrospinal fluid (CSF) shunt operations are associated with infection and require removal or externalization of the shunt, in-hospital treatment with antibiotic agents, and insertion of a new shunt. In a previous survey, the authors identified substantial variation in the duration of antibiotic therapy as well as the duration of hospital stay. The present multicenter pilot study was undertaken to evaluate current strategies in the treatment of shunt infection.


METHODS
Patients were enrolled in the study if they had a successful treatment of a CSF shunt infection proved by culture of a CSF specimen. Details of their care and the incidence of culture-proved reinfection were recorded. Seventy patients from 10 centers were followed up for 1 year after their CSF shunt infection. The initial management of the infection was shunt externalization in 17 patients, shunt removal and external ventricular drain insertion in 50, and antibiotic treatment alone in three. Reinfection occurred in 18 patients (26%). Twelve of the 18 reinfections were caused by the same organism and six were due to new organisms. The treatment time varied from 4 to 47 days, with a mean of 17.4 days for those who later experienced a reinfection compared with 16.2 days for those who did not. The most common organism (Staphylococcus epidermidis, 34 patients) was associated with a reinfection rate of 29% and a mean treatment time of 12.8 days for those who suffered reinfection and 12.5 days for those who did not.


CONCLUSIONS
Reinfection after treatment of a CSF shunt infection is alarmingly common. According to the data available, the incidence of reinfection does not appear to be related to the duration of antibiotic therapy.
Kestle
John R W
JR
Department of Neurosurgery, Primary Children's Medical Center, University of Utah, Salt Lake City, Utah 84113, USA. john.kestle@hsc.utah.edu
Garton
Hugh J L
HJ
Whitehead
William E
WE
Drake
James M
JM
Kulkarni
Abhaya V
AV
Cochrane
D Douglas
DD
Muszynski
Cheryl
C
Walker
Marion L
ML
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D020878:Device Removal; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019370:Observation; D010865:Pilot Projects; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery*; D012086:Reoperation; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents