Management of complicated shunt infections: a clinical report.
OBJECTIVE
The authors present their experience with a protocol for the treatment of patients with complicated shunt infections.


METHODS
Complicated shunt infections are defined for the purpose of this protocol as multiple compartment hydrocephalus, multiple organism shunt infection, severe peritonitis, or infections in other sites of the body. The initial treatment protocol for these patients was 3 weeks of intravenous antibiotic therapy and 2 weeks of twice daily intraventricular/intrashunt antibiotic therapy. Cerebrospinal fluid (CSF) cultures were monitored during therapy and obtained again 48 hours after completion. The shunt was completely replaced. Additionally, follow-up cultures were obtained in all patients 3-6 months after therapy was completed.


RESULTS
A cure of the infection was achieved in all patients as defined by negative cultures obtained at completion of antibiotic therapy and in follow-up studies. The follow-up period was 2-11 years (mean 4.4 +/- 2.5 years). The treatment protocol was modified in the patients treated after 1991, and 18 patients were treated with this modified treatment regime. In these patients, intraventricular antibiotics were administered only once daily for 14 days, and the CSF was cultured 24 hours after antibiotic therapy had been stopped instead of after 48 hours. The results were similar to those obtained with the initial protocol.


CONCLUSIONS
Based on their prospective nonrandomized series, the authors believe that patients with complicated shunt infections can be successfully treated with 2 weeks of intraventricular antibiotic therapy administered once daily, concurrent with 3 weeks of intravenous antibiotic therapy. This protocol reduces length of treatment and hospital stay, and avoids recurrence of infection.
James
Hector E
HE
Lucy Gooding Pediatric Neurosurgery Center, University of Florida Health Sciences Center, Jacksonville, FL 32207, USA. lgpncjax@yahoo.com
Bradley
John S
JS
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000134:cerebrospinal fluid / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000134:cerebrospinal fluid / Q000188:drug therapy*; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D020878:Device Removal; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000188:drug therapy; D007223:Infant; D007275:Injections, Intravenous; D007276:Injections, Intraventricular; D007902:Length of Stay; D008297:Male; D010538:Peritonitis / Q000188:drug therapy; D011183:Postoperative Complications / Q000134:cerebrospinal fluid / Q000188:drug therapy*; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000134:cerebrospinal fluid / Q000188:drug therapy; D012086:Reoperation; D013203:Staphylococcal Infections / Q000188:drug therapy; D013211:Staphylococcus aureus / Q000187:drug effects; D013212:Staphylococcus epidermidis / Q000187:drug effects
D000900:Anti-Bacterial Agents