title: Cerebrospinal fluid shunt infections in children over a 13-year period: anaerobic cultures and comparison of clinical signs of infection with Propionibacterium acnes and with other bacteria.
abstract: OBJECTIVE
  Shunt infections represent a major problem with risk for sequelae and even death. The aim in this retrospective study was to analyze the incidence, origin, and clinical presentation of shunt infections, with special reference to the results of cultures for anaerobic organisms performed in addition to the usual tests, to prolonged incubation times, and to infections caused by Propionibacterium acnes.
  
  
  METHODS
  The medical records of 237 hydrocephalic children (age range 0-15 years) in whom operations were performed by a pediatric surgeon at Uppsala University Hospital during a 13-year period were reviewed.
  
  
  RESULTS
  Thirty-four verified or suspected intraventricular shunt infections and 5 distal catheter infections occurred after 474 operations. Skin bacteria, such as coagulase-negative staphylococci ([CoNS], 19 patients), Staphylococcus aureus (7 patients), and P. acnes (6 patients) predominated. The addition of anaerobic cultures and prolonged incubation times increased the verification of shunt infection by more than one third. Children with P. acnes infection were significantly older, had a lower body temperature, fewer cerebrospinal fluid (CSF) leukocytes, a higher CSF/blood glucose ratio, more distal catheter infections, and other sources of infection. Four had an abdominal pseudocyst. Children < 1 year of age and infected with CoNS were more affected than older children with systemic and local symptoms. In children with distal catheter infection and growth of propionibacteria at the time of the distal catheter and valve replacement, no follow-up antibiotic treatment was necessary.
  
  
  CONCLUSIONS
  Addition of anaerobic cultures and prolonged incubation times led to an increase in the detection of shunt infections. Infections caused by propionibacteria often result in mild symptoms that may be overlooked if adequate anaerobic cultures are not obtained.
authors.affiliation: Department of Pediatric Surgery, Uppsala University Hospital, Uppsala, Sweden. kai.arnell@surgsci.uu.se
authors.forename: Kai
authors.initials: K
authors.lastname: Arnell
authors.forename: Kristina
authors.initials: K
authors.lastname: Cesarini
authors.forename: Angela
authors.initials: A
authors.lastname: Lagerqvist-Widh
authors.forename: Tomas
authors.initials: T
authors.lastname: Wester
authors.forename: Jan
authors.initials: J
authors.lastname: Sjölin
mesh_terms: D000293:Adolescent; D001421:Bacteria, Anaerobic; D020806:Central Nervous System Bacterial Infections / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000601:surgery; D015994:Incidence; D007223:Infant; D011425:Propionibacterium acnes; D012189:Retrospective Studies; D012307:Risk Factors