title: Treatment and microbiology of repeated cerebrospinal fluid shunt infections in children.
abstract: BACKGROUND
  A small group of children have second and even more cerebrospinal fluid (CSF) shunt infections (SIs). We sought to describe the treatment approaches used for, and the microbiology of, repeated SIs.
  
  
  METHODS
  The study population included 31 children with second shunt infection (SI-2) among those undergoing initial CSF shunt placement and treatment for initial infection at Primary Children's Medical Center. CSF SI was defined as follows: (1) presence of bacteria in Gram stain and/or culture of CSF, wound, and/or pseudocyst; (2) visible hardware; (3) abdominal pseudocyst; or (4) presence of bacteria in a blood culture in children with a ventriculoatrial shunt. Infection rates were generated using per-patient denominators, and the concordance of organisms across infections was summarized.
  
  
  RESULTS
  Of the 31 children with SI-2, most were less than 6 months of age at initial shunt placement (81%), male (77%), and with ventriculoperitoneal shunts (71%). Of total, 18 developed SI-3 and 8 developed SI-4. Infection rates were 60% (95% confidence interval [CI]: 42%-75%, n = 18/30) for SI-3 and 47% (95% CI: 26%-69%, n = 8/17) for SI-4. The median time to SI-3 was 477 days (range, 5-828) and to SI-4 it was 2137 days (range, 9-2137). Gram-positive organisms predominated (93% of SI-2, 94% of SI-3). The majority of SI-2 demonstrated Gram-stain concordance with both the initial (first) SI (58%, 95% CI: 41%-74%) and with the following (third) SI (78%, 95% CI: 55%-91%).
  
  
  CONCLUSIONS
  Children with SI-2 experience high subsequent reinfection rates with a long time to reinfection.
authors.affiliation: Department of Pediatrics, University of California at San Francisco, San Francisco, CA, USA.
authors.forename: Teresa J
authors.initials: TJ
authors.lastname: Tuan
authors.forename: Emily A
authors.initials: EA
authors.lastname: Thorell
authors.forename: Nicole Mayer
authors.initials: NM
authors.lastname: Hamblett
authors.forename: John R W
authors.initials: JR
authors.lastname: Kestle
authors.forename: Margaret
authors.initials: M
authors.lastname: Rosenfeld
authors.forename: Tamara D
authors.initials: TD
authors.lastname: Simon
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology*; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial / Q000187:drug effects; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents