title: Antimicrobial treatment options for neurosurgical ventricular shunt infections in children from 1993 to 2012: a systematic review.
abstract: OBJECTIVE
  The aim of this systematic review was to review studies that existed from 1993 to 2012 regarding antimicrobial treatment options of paediatric neurosurgical shunt.
  
  
  METHODS
  Studies were identified from MEDLINE, Scopus and Cochrane databases using a search strategy that was registered on the PROSPERO database. Studies were included if they had two or more patients, aged less than 18 years, and also specified the organism and antimicrobial treatment that was used.
  
  
  RESULTS
  The search yielded 2,985 articles, and 76 articles were suitable for full review. In the final qualitative analysis, only eight studies were included, involving 86 participants. The most common antimicrobial regimens for Gram-positive infections was intravenous and intrathecal vancomycin (n = 7), followed by intravenous vancomycin monotherapy.
  
  
  CONCLUSIONS
  This systematic review has shown that there are no prospective randomised studies of antimicrobial treatment options for paediatric neurosurgical patients in the last 20 years, and larger prospective studies are urgently required for this serious infection. There is some limited case series showing the benefits of certain antimicrobials such as vancomycin and ceftriaxone, but a larger case series or randomised controlled trial is required, particularly to establish the benefit, if any, of additional intraventricular antimicrobials.
authors: Department of Clinical Microbiology, Alder Hey Children's NHS Foundation Trust, Liverpool, L12 2AP, UK, richard.drew@alderhey.nhs.uk.
authors: Richard J
authors: RJ
authors: Drew
authors: Theresa S
authors: TS
authors: Cole
authors: Maggie K
authors: MK
authors: Lee
authors: Stéphane
authors: S
authors: Paulus
authors: Conor L
authors: CL
authors: Mallucci
authors: Andrew
authors: A
authors: Riordan
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000188:drug therapy* / Q000503:physiopathology; D012189:Retrospective Studies; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
chemical_list: D000890:Anti-Infective Agents