title: Evaluation of an institutional guideline for the treatment of cerebrospinal fluid shunt-associated infections.
abstract: BACKGROUND
  Cerebrospinal fluid (CSF) shunt-associated infection is one of the most frequent complications of CSF shunt surgery. We evaluated our institutional guideline for the treatment of shunt-associated infections.
  
  
  METHODS
  We retrospectively analysed all 92 episodes of shunt-associated infections in 78 patients treated in our institution from 2002 to 2008. All patients underwent urgent surgery, i.e. removal of the complete shunt hardware or externalisation of the distal tubing in cases with an infection restricted to the distal shunt (10 %), placement of an external ventricular drainage as necessary and antibiotic therapy. Standard empirical first-line antibiotic treatment consisted of a combination of flucloxacillin and cefuroxime.
  
  
  RESULTS
  We observed 38 % early (<1 month after shunt surgery) and 20 % late infections (> 1 year after shunt placement). Coagulase-negative staphylococci (CoNS) were isolated in 38 %. In 38 % no pathogens could be isolated. Of cases with a first shunt infection, 58 % were initially treated with flucloxacillin/cefuroxime. Only 53 % of all infections were treated successfully with the first course of antibiotics. Only 51 % of bacterial isolates were sensitive to empirical first-line antibiotics. Twenty percent of infections caused by sensitive bacterial isolates nevertheless required second-line antibiotic therapy.
  
  
  CONCLUSIONS
  Urgent surgery for shunt removal and antibiotic therapy will usually cure a shunt-associated infection. The choice of antibiotics should reflect the spectrum of pathogens seen at one's institution, paying particular attention to the role of CoNS isolates, and in vitro sensitivity testing results.
authors.affiliation: Department of Neurosurgery, University Hospital Bonn, Sigmund Freud-Strasse 25, 53105, Bonn, Germany. cvdb@gmx.net
authors.forename: Christian
authors.initials: C
authors.lastname: von der Brelie
authors.forename: Arne
authors.initials: A
authors.lastname: Simon
authors.forename: Alexander
authors.initials: A
authors.lastname: Gröner
authors.forename: Ernst
authors.initials: E
authors.lastname: Molitor
authors.forename: Matthias
authors.initials: M
authors.lastname: Simon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery*; D002444:Cefuroxime / Q000008:administration & dosage*; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D019091:Critical Pathways / Q000592:standards*; D020878:Device Removal; D004359:Drug Therapy, Combination; D005260:Female; D005436:Floxacillin / Q000008:administration & dosage*; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006325:Heart Atria; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery*; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects; D014696:Ventriculostomy; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D005436:Floxacillin; D002444:Cefuroxime